The Steadman Clinic (M.J.P. and J.W.A.), Steadman Philippon Research Institute (M.J.P., J.W.A., and K.K.B.), Vail, Colorado.
Westlake Orthopaedics, Austin, Texas.
J Bone Joint Surg Am. 2020 Sep 16;102(18):1581-1587. doi: 10.2106/JBJS.19.01499.
Labral reconstruction has been shown to result in improved patient-reported outcomes (PROs) at mid-term follow-up in patients with a deficient labrum. The purpose of this study was to determine survivorship and PROs at a minimum 10-year follow-up.
A retrospective evaluation of a prospectively collected single-surgeon database included 91 hips (89 patients) that underwent arthroscopic labral reconstruction with iliotibial band autograft between 2006 and 2008. The primary PRO was the Hip Outcome Score (HOS)-activities of daily living (ADL). The modified Harris hip score (mHHS), HOS-sports, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and patient satisfaction (on a scale of 1 to 10) were also collected at a 10-year minimum follow-up. Survivorship analysis curves were evaluated.
Eighty-two hips were evaluated at a 10-year minimum follow-up. Overall survivorship, with revision hip arthroscopy or total hip arthroplasty (THA) as the end point, was 70% at 5 years and 61% at 10 years, and the mean survival time was 9 years (95% confidence interval = 7.6 to 10 years). For the patients who did not undergo subsequent surgery, on average the mHHS increased from 60 preoperatively to 82 at the 10-year follow-up (p = 0.001), the HOS-ADL improved from 69 to 90 (p = 0.004), the HOS-sports improved from 43 to 76 (p = 0.001), and the median patient satisfaction was 10 of 10. Eighty percent of the patients achieved the minimal clinically important difference (MCID) in the HOS-ADL, and 87% obtained a patient acceptable symptom state (PASS).
Following arthroscopic labral reconstruction with iliotibial band autograft, 9% of the hips underwent revision arthroscopy and 27% underwent THA. At 10 years, the survival rate, with revision hip arthroscopy or THA as the end point, was 61%; however, for those with >2 mm of joint space, the current indication for labral reconstruction, the 10-year survival rate was 90%. Excellent PROs and patient satisfaction were reported by those who did not require revision or THA. With appropriate patient selection and prevention of postoperative adhesions, labral reconstruction results in excellent outcomes and high patient satisfaction that is sustained at a minimum 10-year follow-up.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在有缺陷的盂唇患者中，盂唇重建术在中期随访时已被证明能改善患者报告的结果（PROs）。本研究的目的是确定至少 10 年随访时的生存率和 PROs。
对前瞻性收集的单外科医生数据库进行回顾性评估，包括 2006 年至 2008 年间接受关节镜下盂唇重建术伴阔筋膜张肌髂胫束自体移植物的 91 髋（89 例）。主要的 PRO 是髋关节结果评分（HOS）-日常生活活动（ADL）。改良 Harris 髋关节评分（mHHS）、HOS-运动、西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分以及患者满意度（1 到 10 分）也在至少 10 年的随访时收集。评估生存分析曲线。
82 髋在至少 10 年的随访时进行了评估。以翻修髋关节镜检或全髋关节置换术（THA）为终点，5 年时总体生存率为 70%，10 年时为 61%，平均生存时间为 9 年（95%置信区间=7.6 到 10 年）。对于未行后续手术的患者，平均 mHHS 从术前的 60 分增加到 10 年随访时的 82 分（p=0.001），HOS-ADL 从 69 分提高到 90 分（p=0.004），HOS-运动从 43 分提高到 76 分（p=0.001），患者满意度中位数为 10 分（满分 10 分）。80%的患者在 HOS-ADL 中达到了最小临床重要差异（MCID），87%的患者达到了可接受的患者症状状态（PASS）。
在接受阔筋膜张肌髂胫束自体移植物关节镜下盂唇重建术后，9%的髋关节需要翻修关节镜检，27%需要进行 THA。10 年时，以翻修髋关节镜检或 THA 为终点，生存率为 61%；然而，对于那些有>2mm 关节间隙的患者，即目前盂唇重建的适应证，10 年的生存率为 90%。未行翻修或 THA 的患者报告了出色的 PROs 和患者满意度。通过适当的患者选择和预防术后粘连，盂唇重建可获得出色的结果和高患者满意度，并可在至少 10 年的随访中持续保持。
治疗学 IV 级。请参阅作者说明，以获取完整的证据水平描述。
