Kim Chul-Ho, Moon Jun-Ki, Yoon Jae Youn, Lee Sunhyung, Kim Won Jun, Kim Han Soul, Lee Soong Joon, Yoon Pil Whan
Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon.
Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri-si, Gyunggido.
Medicine (Baltimore). 2020 Dec 4;99(49):e23247. doi: 10.1097/MD.0000000000023247.
Presently, hip arthroscopy is a widely adopted surgical intervention for the treatment of femoroacetabular impingement (FAI). However, there is insufficient evidence regarding which between arthroscopy and nonoperative treatment is more optimal for symptomatic FAI.
MEDLINE, Embase, Web of Science, and the Cochrane Library were systematically searched for studies that compared arthroscopy and nonoperative interventions for FAI treatment from inception to August 4, 2020. We included studies that directly compared surgical and nonsurgical treatment for symptomatic FAI and excluded those that did not use arthroscopic treatment as a surgical technique and studies performed on patients with concomitant diagnoses instead of pure FAI. We compared the following clinical outcome scores at 6 and 12 months of follow-up: International Hip Outcome Tool 33 (iHOT-33), hip outcome score (HOS), EuroQol-visual analog scale (EQ-VAS), modified Harris hip score (mHHS), and nonarthritic hip score (NAHS).
Five studies totaling 838 patients were included in the qualitative and quantitative synthesis; 382 patients underwent hip arthroscopy, and 456 patients were treated by nonoperative interventions. At 6 months of follow-up, there were no statistically significant differences in iHOT-33 ratings (mean difference [MD] = 7.92, P = .15), HOS (MD of HOS-ADL = 5.15, P = .26 and MD of HOS-Sports = 2.65, P = .79, respectively), and EQ-VAS (MD = 1.22, P = .76) between the 2 treatment strategies. At 12 months of follow-up, the arthroscopy group had a greater mean improvement in iHOT-33 score than the conservative treatment group (MD = 8.42, P = .002), but there was no difference between the groups in terms of mHHS rating (MD = -0.24, P = .83) and NAHS (MD = -2.08, P = .09).
Despite arthroscopy being associated with significantly superior iHOT-33 scores after 12 months of follow-up, we were unable to discern the difference between the treatment strategies using other scoring methods, such as HOS, EQ-VAS, mHHS, and NAHS. Further studies will be needed to conclusively determine if 1 strategy is superior to the other for treating FAI.
目前，髋关节镜检查是治疗股骨髋臼撞击症（FAI）广泛采用的手术干预措施。然而，关于关节镜检查和非手术治疗哪种方法对有症状的FAI更优，证据并不充分。
对MEDLINE、Embase、Web of Science和Cochrane图书馆进行系统检索，以查找从开始到2020年8月4日比较关节镜检查和非手术干预治疗FAI的研究。我们纳入了直接比较有症状FAI的手术和非手术治疗的研究，并排除了未将关节镜治疗作为手术技术使用的研究以及对伴有其他诊断而非单纯FAI患者进行的研究。我们比较了随访6个月和12个月时的以下临床结局评分：国际髋关节结局工具33（iHOT - 33）、髋关节结局评分（HOS）、欧洲生活质量视觉模拟量表（EQ - VAS）、改良Harris髋关节评分（mHHS）和非关节炎髋关节评分（NAHS）。
定性和定量综合分析纳入了5项研究，共838例患者；382例患者接受了髋关节镜检查，456例患者接受了非手术干预治疗。在随访6个月时，两种治疗策略在iHOT - 33评分（平均差[MD]=7.92，P = 0.15）、HOS（HOS - ADL的MD = 5.15，P = 0.26；HOS - Sports的MD = 2.65，P = 0.79）和EQ - VAS（MD = 1.22，P = 0.76）方面无统计学显著差异。在随访12个月时，关节镜检查组的iHOT - 33评分平均改善程度大于保守治疗组（MD = 8.42，P = 0.002），但在mHHS评分（MD = - 0.24，P = 0.83）和NAHS（MD = - 2.08，P = 0.09）方面两组无差异。
尽管随访12个月后关节镜检查的iHOT - 33评分明显更高，但我们无法通过其他评分方法（如HOS、EQ - VAS、mHHS和NAHS）辨别治疗策略之间的差异。需要进一步研究以最终确定在治疗FAI方面一种策略是否优于另一种策略。
