接受髋臼周围截骨术（PAO）的发育性髋关节发育不良（DDH）成人患者的身体损伤：一项系统评价和荟萃分析。
Physical impairments in Adults with Developmental Dysplasia of the Hip (DDH) undergoing Periacetabular osteotomy (PAO): A Systematic Review and Meta-Analysis.
作者信息
O'Brien Michael J M, Jacobsen Julie S, Semciw Adam I, Mechlenburg Inger, Tønning Lisa U, Stewart Chris J W, Heerey Joshua, Kemp Joanne L
机构信息
La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark; Research Unit for General Practice, Aarhus, Denmark.
出版信息
Int J Sports Phys Ther. 2022 Oct 1;17(6):988-1001. doi: 10.26603/001c.38166. eCollection 2022.
BACKGROUND
Developmental dysplasia of the hip (DDH) is a condition associated with hip pain and impairments. Periacetabular osteotomy (PAO) is a common surgical treatment for DDH. Outcomes following PAO have historically been based on radiology or patient reported outcomes, and not physical impairments.
OBJECTIVE
To investigate differences in physical impairments in adults with DDH undergoing PAO compared with asymptomatic participants, and to investigate pre- to post-PAO changes in physical impairments.
DESIGN
Systematic review with meta-analysis.
METHODS
A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO), using the PRISMA checklist. Studies were considered eligible if patients were aged 15 years and older, treated with PAO for DDH and if they included a physical impairment outcome measure. Two independent reviewers performed data extraction and assessed methodological quality, using a modified version of the Downs and Black checklist.
RESULTS
Of 5,017 studies, 24 studies were included with 2190 patients. The methodological quality scores ranged from 39% to 88%. With low level of evidence, meta-analysis showed 58% of patients had a positive anterior impingement test (95%CI: 39-76%), prior to PAO and one to three years after PAO. Five years after PAO, the proportion fell to 17% (95%CI: 11-24%). Prior to PAO, patients with DDH walked with a lower peak hip extension angle, compared to asymptomatic participants (SMD 0.65 (95%CI 0.21-1.10). Best evidence synthesis of non-pooled data showed limited evidence of increased walking velocity, stride length and improved hip flexion and extension moment 18-months post-PAO compared to pre-op. Cadence, hip abduction and hip flexion strength did not change.
CONCLUSION
Most patients with DDH have a positive hip impingement test, pre-PAO. Compared to asymptomatic participants, patients with DDH demonstrate physical impairments during walking which appear to improve after surgery. Hip abduction and flexion strength did not change pre- to post-PAO.
LEVEL OF EVIDENCE
1b.
背景
发育性髋关节发育不良（DDH）是一种与髋关节疼痛和功能障碍相关的病症。髋臼周围截骨术（PAO）是治疗DDH的一种常见手术方法。以往PAO术后的疗效评估一直基于影像学检查或患者报告的结果，而非身体功能障碍情况。
目的
研究接受PAO手术的成年DDH患者与无症状参与者在身体功能障碍方面的差异，并探讨PAO术前至术后身体功能障碍的变化。
设计
系统评价并进行荟萃分析。
方法
按照PRISMA清单在五个数据库（MEDLINE、CINAHL、EMBASE、Sports Discuss和PsychINFO）中进行文献检索。若患者年龄在15岁及以上，因DDH接受PAO治疗且研究包含身体功能障碍结局指标，则该研究被视为合格。两名独立评审员使用修改后的唐斯和布莱克清单进行数据提取并评估方法学质量。
结果
在5017项研究中，纳入了24项研究，共2190例患者。方法学质量得分在39%至88%之间。由于证据水平较低，荟萃分析显示，58%的患者在PAO术前及术后1至3年的前撞击试验结果为阳性（95%置信区间：39 - 76%）。PAO术后5年，这一比例降至17%（95%置信区间：11 - 24%）。与无症状参与者相比，PAO术前DDH患者行走时髋关节伸展峰值角度较低（标准化均数差0.65（95%置信区间0.21 - 1.10））。对非汇总数据的最佳证据综合分析显示，与术前相比，PAO术后18个月时步行速度、步幅增加以及髋关节屈伸力矩改善的证据有限。步频、髋关节外展和髋关节屈曲力量未发生变化。
结论
大多数DDH患者在PAO术前髋关节撞击试验结果为阳性。与无症状参与者相比，DDH患者在行走时存在身体功能障碍，术后似乎有所改善。PAO术前至术后髋关节外展和屈曲力量未发生变化。
证据水平
1b。
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