Wu Zhan-Xiong, Ren Wen-Xia, Ren Yi-Ming, Tian Meng-Qiang
Department of Orthopedics, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences.
Endocrine and Metabolic Center, Taiyuan Central Hospital, Taiyuan, Shanxi Province.
Medicine (Baltimore). 2020 May;99(19):e20141. doi: 10.1097/MD.0000000000020141.
Femoroacetabular impingement (FAI) is a common cause of hip pain and even tearing of the acetabular labrum in young adults and athletes. Either arthroscopic labral debridement (LD) or labral repair (LR) technique for FAI patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic LD versus LR intervention.
The five studies were acquired from PubMed, Medline, Embase, and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias.
Four observational studies and one prospective randomized study were assessed. The methodological quality of the trials indicated a low to moderate risk of bias. The pooled results of Non-Arthritic Hip Score (NAHS), failure rate of surgeries and complications showed that the differences were not statistically significant between the two interventions. The difference of modified Harris Hip Score (mHHS), the Visual Analogue Scale (VAS) score and satisfaction rate was statistically significant between LD and LR intervention, and LR treatment was more effective. Sensitivity analysis proved the stability of the pooled results and there were too less included articles to verify the publication bias.
Hip arthroscopy with either LR or LD is an effective treatment for symptomatic FAI. The difference of mHHS, VAS score, and satisfaction rate was statistically significant between LD and LR intervention, and arthroscopic LR could re-create suction-seal effect, potentially reduce microinstability, which demonstrated a trend toward better clinical efficacy and comparable safety compared with LD. The arthroscopic LR technique is recommended as the optical choice for acetabular labrum tear with FAI.
股骨髋臼撞击症（FAI）是导致年轻人和运动员髋关节疼痛甚至髋臼盂唇撕裂的常见原因。对于FAI患者，需要选择关节镜下盂唇清创术（LD）或盂唇修复术（LR）。我们进行了这项系统评价和荟萃分析，以比较关节镜下LD与LR干预的临床疗效。
从PubMed、Medline、Embase和Cochrane图书馆获取了五项研究。数据由两名共同作者独立提取，并使用RevMan5.3进行分析。计算平均差（MDs）、比值比（ORs）和95%置信区间（CIs）。采用Cochrane协作网的偏倚风险工具和纽卡斯尔-渥太华量表评估偏倚风险。
评估了四项观察性研究和一项前瞻性随机研究。试验的方法学质量表明偏倚风险为低到中度。非关节炎髋关节评分（NAHS）、手术失败率和并发症的汇总结果显示，两种干预措施之间的差异无统计学意义。LD与LR干预之间改良Harris髋关节评分（mHHS）、视觉模拟量表（VAS）评分和满意度的差异有统计学意义，且LR治疗更有效。敏感性分析证明了汇总结果的稳定性，纳入的文章太少，无法验证发表偏倚。
LR或LD的髋关节镜检查是治疗有症状FAI的有效方法。LD与LR干预之间mHHS、VAS评分和满意度的差异有统计学意义，关节镜下LR可以重建抽吸密封效应，潜在地减少微不稳定，与LD相比，显示出更好的临床疗效和相当安全性的趋势。关节镜下LR技术被推荐为治疗FAI合并髋臼盂唇撕裂的最佳选择。
