American Hip Institute, Westmont, U.S.A.; Loyola Stritch College of Medicine, Chicago, Illinois, U.S.A.
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, Arizona, U.S.A.
Arthroscopy. 2019 Jul;35(7):2037-2047. doi: 10.1016/j.arthro.2019.01.047. Epub 2019 May 5.
To elucidate the effect, if any, of acetabular chondral defect size on surgical outcomes after arthroscopic microfracture was performed with concomitant treatment for labral tears and femoroacetabular impingement (FAI) syndrome.
The study period was between February 2008 and November 2014. Data were collected on patients who underwent hip arthroscopy. The inclusion criteria were acetabular microfracture; concomitant treatment for labral tears and FAI syndrome; and preoperative modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale. Exclusion criteria were Workers' Compensation, preoperative Tönnis grade >1, or previous ipsilateral hip surgeries or conditions. Patients were grouped based on smaller chondral defects (SCDs) or larger chondral defects (LCDs), then matched 1:1 by age at surgery ±10 years, sex, body mass index ±5, labral treatment, capsular treatment, acetabuloplasty, and femoroplasty. Outcomes, secondary arthroscopies, and conversions to total hip arthroplasty (THA) were documented.
Of 131 eligible cases, 107 (81.7%) had minimum 2-year follow-up. Before matching, the conversion rate to THA was higher for LCDs (24.6%) than for SCDs (12.0%). Thirty-five patients were matched for each group. Mean follow-up time was 47.9 months (range, 24.0, 84.1) for the matched LCD group and 46.1 months (range, 24.0, 88.1) for the matched SCD group. Ligamentum teres debridement (P = .03) was performed more frequently in the LCD group. No other differences were found regarding demographics, intraoperative findings, procedures, traction time, preoperative scores, or follow-up scores. Both groups demonstrated significant improvements in all scores. Rates of revision or conversion to THA were similar between groups. The relative risk for conversion to THA was 2.33 for patients with defects ≥300 mm compared with patients with defects ≤250 mm (P = .13). Deep vein thrombosis occurred in 3 (5.3%) patients with LCDs.
Matched patients with either SCDs or LCDs undergoing arthroscopic acetabular microfracture with concomitant treatment for labral tears and FAI syndrome demonstrated similar improvements at minimum 2-year follow-up. Patients with chondral defects approaching 300 mm or greater may have a higher propensity toward conversion to THA.
Level III, retrospective comparative therapeutic trial.
阐明髋臼软骨缺损大小对关节镜下微骨折术治疗合并髋关节盂唇撕裂和股骨髋臼撞击综合征（FAI 综合征）的影响。
研究时间为 2008 年 2 月至 2014 年 11 月。收集接受髋关节镜检查的患者数据。纳入标准为髋臼微骨折；合并治疗盂唇撕裂和 FAI 综合征；术前改良 Harris 髋关节评分、非关节炎髋关节评分、髋关节结局评分-运动特异性亚量表和视觉模拟评分。排除标准为工人赔偿、术前 Tönnis 分级>1 或同侧髋关节手术或疾病。根据较小的软骨缺损（SCD）或较大的软骨缺损（LCD）将患者分组，然后按手术时年龄±10 岁、性别、体重指数±5、盂唇治疗、囊治疗、髋臼成形术和股骨成形术进行 1:1 匹配。记录结果、二次关节镜检查和转为全髋关节置换术（THA）。
在 131 例符合条件的病例中，107 例（81.7%）有至少 2 年的随访。在匹配之前，LCD 组（24.6%）的 THA 转化率高于 SCD 组（12.0%）。每组匹配 35 例患者。匹配的 LCD 组的平均随访时间为 47.9 个月（范围，24.0，84.1），匹配的 SCD 组为 46.1 个月（范围，24.0，88.1）。LCD 组更频繁地进行了圆韧带清创术（P=.03）。在人口统计学、术中发现、手术程序、牵引时间、术前评分或随访评分方面没有发现其他差异。两组在所有评分中均有显著改善。两组之间翻修或转为 THA 的比率相似。与缺陷≤250mm 的患者相比，缺陷≥300mm 的患者转为 THA 的相对风险为 2.33（P=.13）。3 例（5.3%）LCD 患者发生深静脉血栓形成。
在接受关节镜髋臼微骨折术治疗合并髋关节盂唇撕裂和 FAI 综合征的 SCD 或 LCD 患者中，匹配患者在至少 2 年的随访中表现出相似的改善。软骨缺损接近 300mm 或更大的患者可能更倾向于转为 THA。
III 级，回顾性比较治疗试验。
