Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
Orthop Traumatol Surg Res. 2023 Jun;109(4):103349. doi: 10.1016/j.otsr.2022.103349. Epub 2022 Jun 7.
The role of arthroscopic treatment of femoroacetabular impingement (FAI) in mild or borderline hip dysplasia (lateral center edge angle=18-25) is controversial. It is recommended to combine capsular plication with femoral neck osteoplasty and suture repair of the labrum. Few studies have investigated which radiological parameters are associated with failure of this procedure.
A larger number of radiological signs of mild or borderline hip dysplasia than radiological signs of FAI negatively influence the outcomes of arthroscopic treatment.
This was a retrospective study done with data collected prospectively after a minimum of 2 years' follow-up in patients who underwent arthroscopic treatment of FAI due to cam impingement combined with mild to moderate hip dysplasia. Patients with hip osteoarthritis graded as ≥ Tönnis 2 were excluded. Functional outcome scores (mHHS and NAHS) were determined along with the need for reoperation. Three groups were defined based on the outcomes: success (mHHS ≥ Patient Acceptable Symptomatic State [PASS]); moderate improvement (improvement in mHHS + mHHS<PASS) and failure (worsening of the mHHS). Demographic data, radiographic parameters (LCEA, Tönnis angle, alpha angle, offset, FEAR index, Shenton's line, Cliff sign, anterior wall index [AWI], posterior wall index [PWI]) and intraoperative findings were compared between these three groups. The area under the curve (AUC) for the most relevant data identified during the univariate analysis were then modeled to define which factors were the best at predicting failed arthroscopic treatment a posteriori.
The study analyzed 39 patients. The mean mHHS was 76±15 [40-92]. The "success" group consisted of 21 patients (56%, 21/39), the "moderate improvement" group of 12 patients (31%, 12/39) and the failure group of 6 patients (13%, 6/39) (2 subsequently underwent total hip replacement, 4 underwent shelf acetabuloplasty). The FEAR index was significantly higher and the AWI and VCE were significantly lower in the "failure" group. The FEAR index was the best predictive factor; an index ≥ 4° detected 100% of failures with 96% specificity. The patients in the "moderate improvement" group were significantly older (37 years±8 [18-45]<p= 0.04) with a significantly higher offset (2mm±3 [-5-5]<p=0.004); an offset ≥ 2mm could detect 73% of them with a specificity of 72%.
A FEAR index ≥ 4° and offset ≥ 2mm is best able to detect patients at risk of failure and unsatisfactory results, respectively, in the mild clinical cam-type impingement in a population of FAI patients.
IV, retrospective series.
对于轻度或临界髋臼发育不良（外侧中心边缘角=18-25）的股骨髋臼撞击症（FAI），关节镜治疗的作用存在争议。建议行关节囊切开术联合股骨颈骨成形术，并修复盂唇。很少有研究探讨哪些影像学参数与该手术的失败有关。
与 FAI 的影像学征象相比，轻度或临界髋臼发育不良的影像学征象越多，会对关节镜治疗的结果产生负面影响。
这是一项回顾性研究，对因凸轮撞击症合并轻度至中度髋臼发育不良而接受关节镜治疗 FAI 的患者进行前瞻性数据收集，随访时间至少 2 年。排除髋关节骨关节炎分级≥Tönnis 2 的患者。确定功能结局评分（mHHS 和 NAHS）和再次手术的需要。根据结果将患者分为三组：成功（mHHS≥患者可接受的症状状态[PASS]）；中度改善（mHHS 改善+ mHHS<PASS）和失败（mHHS 恶化）。比较三组之间的人口统计学数据、影像学参数（LCEA、Tönnis 角、alpha 角、偏移量、FEAR 指数、Shenton 线、Cliff 征、前壁指数[AWI]、后壁指数[PWI]）和术中发现。然后对单变量分析中确定的最相关数据的曲线下面积（AUC）进行建模，以确定哪些因素最能预测术后关节镜治疗失败。
本研究共分析了 39 例患者。平均 mHHS 为 76±15[40-92]。“成功”组有 21 例患者（56%，21/39），“中度改善”组有 12 例患者（31%，12/39），“失败”组有 6 例患者（13%，6/39）（2 例随后接受全髋关节置换术，4 例接受髋臼成形术）。“失败”组的 FEAR 指数显著升高，而 AWI 和 VCE 显著降低。FEAR 指数是最佳的预测因素；指数≥4°可检测到 100%的失败病例，特异性为 96%。“中度改善”组患者的年龄明显更大（37 岁±8[18-45]，p=0.04），偏移量明显更大（2mm±3[-5-5]，p=0.004）；偏移量≥2mm 可检测到 73%的患者，特异性为 72%。
在 FAI 患者中，对于轻度临床凸轮型撞击症患者，FEAR 指数≥4°和偏移量≥2mm 分别能够最好地检测出有发生失败和结果不满意风险的患者。
IV，回顾性研究。
