Tey-Pons Marc, Capurro Bruno, Torres-Eguia Raúl, Marqués-López Fernando, Leon-García Alfonso, Marín-Peña Oliver
Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Barcelona 08003, Spain.
iMove Traumatología, Clínica Mi Tres Torres, Barcelona 08017, Spain.
J Hip Preserv Surg. 2021 Jun 23;8(Suppl 1):i34-i40. doi: 10.1093/jhps/hnab030. eCollection 2021 Jun.
Surgical treatment of labral injuries has shifted from debridement to preservation over the past decades. Primary repair and secondary augmentation or reconstruction techniques are aimed at restoring the labral seal and preserving or improving contact mechanics. Currently, the standard of care for non-repairable tears favours the use of auto- or allografts. As an alternative, we present our initial experience using a synthetic, off-the-shelf polyurethane scaffold for augmentation and reconstruction of segmental labral tissue loss or irreparable labral damage. Three patients aged 37-44 (two male, one female) with femoroacetabular impingement without associated dysplasia (Wiberg > 25°) or osteoarthritis (Tönnis <2) were included in this series. Labral reconstruction (one case) and augmentation (two cases) were performed using a synthetic polyurethane scaffold developed for meniscal substitution (Actifit, Orteq Ltd, London, UK) and adapted to the hip. Clinical results were analysed with patient-reported outcomes (PROMs) using non-arthritic hip score (NAHS) and daily live activities hip outcome score (DLA HOS) and magnetic resonance images (MRI) at 2- and 4-year follow-up. Clinically improvement was seen in all PROMs at 4 years. The NAHS scores improved from 57.7 to 82.3 (50.9% improvement) and HOS from 59 to 79.3 (35.3% improvement). Last follow-up MRIs confirmed the presence of the scaffold; however, the scaffold signal was still hyperintense compared to native labrum. There was no shrinkage in any scaffold and no progression to hip osteoarthritis seen. Reconstruction or augmentation of segmental labral defects with a polyurethane scaffold may be an effective procedure. At 4 years after implantation, our small cases series resulted in improved hip joint function, reduced pain and scaffold preservation on follow-up imaging.
在过去几十年中，髋臼唇损伤的手术治疗已从清创术转向保留术。初次修复以及二次增强或重建技术旨在恢复髋臼唇密封，并保留或改善接触力学。目前，对于不可修复的撕裂伤，标准治疗方法倾向于使用自体移植物或同种异体移植物。作为一种替代方法，我们介绍了使用现成的合成聚氨酯支架来增强和重建节段性髋臼唇组织缺损或不可修复的髋臼唇损伤的初步经验。本系列纳入了3例年龄在37 - 44岁之间的患者（2例男性，1例女性），均患有股骨髋臼撞击症，无相关发育异常（Wiberg角>25°）或骨关节炎（Tönnis分级<2级）。使用一种为半月板置换开发的合成聚氨酯支架（Actifit，Orteq有限公司，英国伦敦）并针对髋关节进行适配，实施了髋臼唇重建（1例）和增强（2例）手术。在2年和4年随访时，使用患者报告结局（PROMs），通过非关节炎髋关节评分（NAHS）和日常生活活动髋关节结局评分（DLA HOS）以及磁共振成像（MRI）对临床结果进行分析。4年时所有PROMs均显示临床改善。NAHS评分从57.7提高到82.3（提高了50.9%），HOS评分从59提高到79.3（提高了35.3%）。最后一次随访的MRI证实了支架的存在；然而，与天然髋臼唇相比，支架信号仍为高信号。任何支架均未出现收缩，也未进展为髋关节骨关节炎。用聚氨酯支架重建或增强节段性髋臼唇缺损可能是一种有效的手术方法。植入后4年，我们的小病例系列显示髋关节功能改善、疼痛减轻且随访成像显示支架得以保留。
