Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.
Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada.
Arthroscopy. 2019 Sep;35(9):2598-2605.e1. doi: 10.1016/j.arthro.2019.03.030.
To quantify the prevalence of sacroiliac joint (SIJ) abnormalities in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) by use of various imaging modalities and to compare outcomes based on SIJ abnormalities.
Plain radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans of patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. The exclusion criteria included patients undergoing bilateral or revision surgery, those with a history of dysplasia, and those with less than 2 years' follow-up. On radiographs, the SIJs were graded using modified New York criteria for spondyloarthropathy. CT and MRI scans were reviewed for joint surface erosion, subchondral sclerosis, joint space narrowing, pseudo-widening, bone marrow edema, and ankylosis. Patients with SIJ abnormalities were matched to patients without SIJ abnormalities in a 1:2 ratio by age and body mass index. Outcomes included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain, and VAS for satisfaction.
Of 1,009 consecutive patients, 743 (73.6%) were included; 187 (25.2%) showed SIJ changes. Of these 187 patients, 164 (87.7%) had changes on plain radiographs, 88 (47.1%) had changes on CT, and 125 (66.8%) had changes on MRI. SIJ changes on any imaging modality were weakly correlated with pain to palpation of the SIJ (r = 0.11, P = .004) on physical examination. Pain to palpation of the SIJ on physical examination (odds ratio [OR], 1.12; P = .031) and a history of SIJ pain (OR, 1.93; P = .018) increased the odds of having an SIJ abnormality on any imaging modality. After matching, patients without SIJ abnormalities had a significantly greater HOS-ADL (95.4 vs 90.6, P = .001), HOS-SS (91.1 vs 77.5, P < .001), and mHHS (91.3 vs 84.5, P < .001) and a significantly lower VAS pain score (10.9 vs 25.7, P < .001) than patients with abnormalities at a mean follow-up of 34.1 ± 9.7 months (range, 24-54 months). Patients without SIJ abnormalities had greater odds of achieving the minimal clinically important difference for the HOS-ADL (OR, 2.91; P = .001) and for the HOS-SS (OR, 2.83; P < .001) but not for the mHHS (OR, 1.73; P = .081).
A high prevalence of SIJ abnormalities (25.2%) is seen on imaging in FAIS patients. These patients may show significantly inferior clinical outcomes and persistent postoperative pain after FAIS treatment. The results of this study may allow treating orthopaedic surgeons to better inform patients with SIJ abnormalities that they may not achieve clinically significant outcome improvement after hip arthroscopy.
Level III, retrospective comparative study.
通过使用各种影像学方法来量化在接受髋关节镜检查治疗股骨髋臼撞击综合征（FAIS）的患者中骶髂关节（SIJ）异常的发生率，并根据 SIJ 异常比较治疗结果。
回顾性分析了 2012 年 1 月至 2016 年 1 月期间因 FAIS 接受初次髋关节镜检查的患者的普通 X 线片、计算机断层扫描（CT）和磁共振成像（MRI）。排除标准包括接受双侧或翻修手术的患者、存在发育不良病史的患者以及随访时间少于 2 年的患者。在 X 线片上，使用改良的纽约脊柱关节病分类标准对 SIJ 进行分级。对 CT 和 MRI 扫描进行关节面侵蚀、软骨下硬化、关节间隙变窄、假性增宽、骨髓水肿和强直的评估。根据年龄和体重指数，将有 SIJ 异常的患者与无 SIJ 异常的患者以 1:2 的比例进行匹配。结果包括髋关节功能评分-日常生活活动（HOS-ADL）、髋关节功能评分-运动亚量表（HOS-SS）、改良 Harris 髋关节评分（mHHS）、疼痛视觉模拟量表（VAS）和满意度 VAS。
在连续 1009 例患者中，743 例（73.6%）符合纳入标准；187 例（25.2%）存在 SIJ 改变。在这 187 例患者中，164 例（87.7%）在普通 X 线片上有改变，88 例（47.1%）在 CT 上有改变，125 例（66.8%）在 MRI 上有改变。体格检查时 SIJ 触诊疼痛与任何影像学方法上的 SIJ 改变具有弱相关性（r=0.11，P=0.004）。SIJ 触诊疼痛（比值比[OR]，1.12；P=0.031）和 SIJ 疼痛史（OR，1.93；P=0.018）增加了任何影像学方法上存在 SIJ 异常的可能性。匹配后，无 SIJ 异常的患者 HOS-ADL（95.4 比 90.6，P=0.001）、HOS-SS（91.1 比 77.5，P<0.001）和 mHHS（91.3 比 84.5，P<0.001）更高，疼痛 VAS 评分（10.9 比 25.7，P<0.001）更低，平均随访 34.1±9.7 个月（范围 24-54 个月）。无 SIJ 异常的患者获得 HOS-ADL（OR，2.91；P=0.001）和 HOS-SS（OR，2.83；P<0.001）最小临床重要差异的可能性更高，但 mHHS（OR，1.73；P=0.081）的可能性没有差异。
在 FAIS 患者中，影像学上 SIJ 异常的发生率较高（25.2%）。这些患者在接受 FAIS 治疗后可能会出现明显较差的临床结果和持续的术后疼痛。本研究的结果可能使骨科医生更好地告知存在 SIJ 异常的患者，他们在髋关节镜检查后可能无法获得显著的临床改善。
III 级，回顾性比较研究。
