University of Wisconsin-Madison.
Arthroscopy. 2021 Jun;37(6):1829-1832. doi: 10.1016/j.arthro.2021.03.027. Epub 2021 Mar 19.
Hip arthroscopy use has grown as a result of expanding indications; improved imaging including higher resolution magnetic resonance imaging with stronger magnetic fields and the advent of 3-dimensional computed tomography revealing the nuances of hip joint morphology; increased specialized training; improvements in instruments and implants; a record of successful outcomes; and increased understanding of microinstability, focal acetabular undercoverage or occult dysplasia, indications for labral reconstruction and capsular plication, and, most of all, femoroacetabular impingement syndrome, the leading diagnosis for which hip arthroscopy is performed, in the orthopaedic community as well as the general medical and athletic communities. We now know that labral repair results in better outcomes than labral debridement, and evidence suggests that capsule closure leads to better long-term success. Osteoarthritis and its correlate, advanced age, result in inferior survivorship after hip arthroscopy, which is unsurprising; hip preservation surgery is not designed to treat irreparable cartilage damage. Association of female sex with hip arthroscopy failure requires additional investigation. More females undergo hip arthroscopy than males, and females initially present with greater disability. Females tend to have smaller alpha angles, greater femoral and acetabular anteversion, and lower center edge angles than males, consistent with increased prevalence of hip dysplasia. Thus surgeons indicating females for hip arthroscopy should be aware of atypical locations of cam lesions, borderline dysplasia, or ligamentous laxity, all of which must be appropriately respected at the time of surgery. With all of the improvements we have made in techniques, patient diagnosis and surgical indications, and our overall understanding of complex anatomy and a technically challenging surgery, we can speculate that our long-term survivorship will only improve. I await with interest the long-term outcomes we will see 10 years from today, with the addition of insight from patient-reported outcome measures to answer these questions with greater certainty.
髋关节镜检查的应用不断增加，原因包括：适应证不断扩大；影像学检查不断改进，包括磁场强度更高、分辨率更高的磁共振成像和能更清晰显示髋关节形态细微结构的三维计算机断层扫描；专业化培训增加；器械和植入物不断改进；成功治疗结果记录不断增加；对髋关节微不稳定、髋臼覆盖不足或隐匿性发育不良、盂唇重建和囊袋紧缩适应证的认识不断提高，最重要的是，对股骨髋臼撞击综合征（髋关节镜检查最主要的适应证）的认识不断提高，这些都得到了骨科界以及普通医疗和运动医学界的认可。我们现在知道，盂唇修复的效果优于盂唇清创术，而且有证据表明，囊袋闭合可带来更好的长期效果。髋关节镜检查后，骨关节炎及其相关的高龄会导致髋关节预后较差，这并不令人意外；髋关节保髋手术并非设计用于治疗不可修复的软骨损伤。女性髋关节镜检查失败与女性相关，需要进一步研究。接受髋关节镜检查的女性多于男性，而且女性最初的残疾程度更高。女性的阿尔法角较小、股骨和髋臼前倾角度较大、中心边缘角较低，这与髋关节发育不良的发病率较高一致。因此，为女性患者进行髋关节镜检查的外科医生应该注意到凸轮病变、临界发育不良或韧带松弛的非典型位置，所有这些在手术时都必须得到适当的重视。随着我们在技术、患者诊断和手术适应证方面取得的所有进步，以及我们对复杂解剖结构和具有挑战性的技术手术的整体理解，我们可以推测我们的长期预后只会有所改善。我很期待在未来十年看到我们的长期预后，同时，患者报告的结果测量也将为我们提供更明确的答案，帮助我们回答这些问题。
