Yang Fan, Huang Hong-Jie, He Zi-Yi, Xu Yan, Zhang Xin, Wang Jian-Quan
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Orthop J Sports Med. 2022 Sep 29;10(9):23259671221125509. doi: 10.1177/23259671221125509. eCollection 2022 Sep.
Inadequate resection of cam lesions can cause inferior outcomes after hip arthroscopy and result in revision surgery for femoroacetabular impingement syndrome (FAIS).
To evaluate the association between postoperative cam lesions measured using the proximal boundaries of resection area (PBRE) relative to the epiphyseal line and 2-year outcomes after hip arthroscopy.
Cohort study; Level of evidence, 3.
Included were patients with FAIS who had undergone primary hip arthroscopy between 2016 and 2018. The PBRE was calculated by measuring the linear distance from the PBRE to the epiphyseal line, dividing it by the diameter of the femoral head, and multiplying by 100; PBRE measurements were made at the 12-, 1-, and 2-o'clock positions on postoperative hip computed tomography. Within each clockface position, patients were divided into subgroups depending on whether their postoperative PBRE was greater than a half standard deviation above the mean (adequate resection) or less than or equal to a half standard deviation above the mean (inadequate resection). Patient-reported outcomes (PROs; Hip Outcome Score-Activities of Daily Living [HOS-ADL], International Hip Outcome Tool-Short Form [iHOT-12], modified Harris Hip Score [mHHS], and pain visual analog scale [VAS]) and rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) were compared among the subgroups.
Included were 80 pairs of hips at 12 o'clock, 81 pairs of hips at 1 o'clock, and 80 pairs of hips at 2 o'clock. All subgroups demonstrated significant improvements in PRO scores at a minimum 2-year follow-up compared with preoperatively. At the 12-o'clock position, the subgroup with adequate resection had significantly superior HOS-ADL ( = .004), iHOT-12 ( < .001), and mHHS ( < .001) scores and were more likely to achieve the MCID for the iHOT-12 score ( = .035) and the PASS for the HOS-ADL ( = .003), iHOT-12 ( = .007), and mHHS ( < .001) scores compared with the matched subgroup. There were no significant differences in PRO scores or rates of MCID and PASS for the 1- or 2-o'clock groups.
The epiphyseal line may be a useful and reproducible landmark measurement for cam-type deformity. Patients considered to have inadequate resection at 12 o'clock had lower outcome scores at a minimum 2-year follow-up.
凸轮病变切除不充分会导致髋关节镜检查后效果不佳，并导致股骨髋臼撞击综合征（FAIS）的翻修手术。
评估使用相对于骨骺线的切除区域近端边界（PBRE）测量的术后凸轮病变与髋关节镜检查后2年的疗效之间的关联。
队列研究；证据等级，3级。
纳入2016年至2018年间接受初次髋关节镜检查的FAIS患者。PBRE通过测量从PBRE到骨骺线的直线距离，将其除以股骨头直径，再乘以100来计算；在术后髋关节计算机断层扫描上的12点、1点和2点位置进行PBRE测量。在每个钟面位置内，根据术后PBRE是否大于均值上方半个标准差（切除充分）或小于或等于均值上方半个标准差（切除不充分）将患者分为亚组。比较亚组之间患者报告的结局（PROs；髋关节结局评分-日常生活活动[HOS-ADL]、国际髋关节结局工具-简表[iHOT-12]、改良Harris髋关节评分[mHHS]和疼痛视觉模拟量表[VAS]）以及达到最小临床重要差异（MCID）和患者可接受症状状态（PASS）的比率。
纳入了12点位置的80对髋关节、1点位置的81对髋关节和2点位置的80对髋关节。与术前相比，所有亚组在至少2年的随访中PRO评分均有显著改善。在12点位置，切除充分的亚组在HOS-ADL（P = .004）、iHOT-12（P < .001）和mHHS（P < .001）评分方面显著更高，并且与匹配的亚组相比，更有可能达到iHOT-12评分的MCID（P = .035）以及HOS-ADL（P = .003）、iHOT-12（P = .007）和mHHS（P < .001）评分的PASS。1点或2点组的PRO评分、MCID和PASS比率没有显著差异。
骨骺线可能是凸轮型畸形的一个有用且可重复的标志性测量指标。在12点位置被认为切除不充分的患者在至少2年的随访中结局评分较低。
