对接受初次髋关节镜检查的边缘性发育不良患者的中长期预后良好：一项系统评价。
Mid- and Long-Term Outcomes Are Favorable for Patients With Borderline Dysplasia Undergoing Primary Hip Arthroscopy: A Systematic Review.
作者信息
Lee Michael S, Owens Jade S, Fong Scott, Kim David N, Gillinov Stephen M, Mahatme Ronak J, Simington Jacquelyn, Monahan Peter F, Islam Wasif, Moran Jay, Grimm Nathan L, Jimenez Andrew E
机构信息
Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
Keck School of Medicine of the University of Southern California, Los Angeles, California.
出版信息
Arthroscopy. 2023 Apr;39(4):1060-1073. doi: 10.1016/j.arthro.2022.12.030. Epub 2022 Dec 31.
PURPOSE
To evaluate midterm outcomes, long-term outcomes, and survivorship in the borderline dysplastic population after primary hip arthroscopy.
METHODS
A systematic review of current literature was performed with the following key words: "hip, "arthroscopy," "borderline dysplasia," "borderline hip dysplasia," "developmental dysplasia," "ten-year," "survivorship," "10-year," "5-year," "five year," "mid-term," "long-term," "outcomes," "arthroscopic," and "femoroacetabular impingement" in PubMed, Cochrane, and Scopus in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The following information was recorded: title, author, publication date, study design, demographic, number of hips, follow-up time, study period, indications for hip arthroscopy, patient-reported outcomes (PROs), characteristics of patients converting to total hip arthroplasty (THA), and rates of secondary surgeries and conversion to THA were recorded. Survivorship was defined as not converting to THA. Kappa values for the title/abstract and full-text screening were calculated. Forest plots were created for PROs that were included in 3 or more studies.
RESULTS
Six articles comprising 413 hips were included in the study. Three studies were Level III evidence, and 3 studies were Level IV evidence. Average follow-up ranged from 5.7 to 12.2 years. One study defined borderline hip dysplasia as lateral center-edge angle 18-25° and 5 defined it as lateral center-edge angle 20-25°. All studies included PROs and reported significant improvement after surgery in at least one PRO. Three studies reported clinical benefit and across the studies at least 70% of patients achieved minimum clinically important difference in at least one PRO. Rates of undergoing revision hip arthroscopy and THA ranged from 2.1% to 7% and 0% to 24%, respectively. Tönnis grade 2, Tönnis angle >15, and Outerbridge Grade IV cartilage damage were identified as predictors of conversion to THA.
CONCLUSIONS
Patients with borderline hip dysplasia undergoing primary hip arthroscopy demonstrated significant improvement in PROs at midterm and long-term follow-up. Survivorship at midterm follow-up was 98.2% (328/334 hips) and 76.3% (29/38 hips) at long-term follow-up.
LEVEL OF EVIDENCE
Level IV, systematic review of Level III and Level IV studies.
目的
评估初次髋关节镜检查后临界发育不良人群的中期结果、长期结果和生存率。
方法
于2022年3月，在PubMed、Cochrane和Scopus数据库中，使用系统评价和Meta分析的首选报告项目指南，以“髋关节”“关节镜检查”“临界发育不良”“临界髋关节发育不良”“发育性发育不良”“十年”“生存率”“10年”“5年”“中期”“长期”“结果”“关节镜检查的”和“股骨髋臼撞击症”为关键词，对当前文献进行系统评价。记录以下信息：标题、作者、出版日期、研究设计、人口统计学数据、髋关节数量、随访时间、研究周期、髋关节镜检查的指征、患者报告的结果（PROs）、转为全髋关节置换术（THA）的患者特征，以及二次手术率和转为THA的比率。生存率定义为未转为THA。计算标题/摘要和全文筛选的Kappa值。为纳入3项或更多研究的PROs绘制森林图。
结果
该研究纳入了6篇文章，共413例髋关节。3项研究为III级证据，3项研究为IV级证据。平均随访时间为5.7至12.2年。1项研究将临界髋关节发育不良定义为外侧中心边缘角18 - 25°，5项研究将其定义为外侧中心边缘角20 - 25°。所有研究均纳入了PROs，并报告至少在一项PROs中术后有显著改善。3项研究报告了临床益处，且在所有研究中，至少70%的患者在至少一项PROs中达到了最小临床重要差异。翻修髋关节镜检查和THA的发生率分别为2.1%至7%和0%至24%。Tönnis分级2级、Tönnis角>15以及Outerbridge IV级软骨损伤被确定为转为THA的预测因素。
结论
接受初次髋关节镜检查的临界髋关节发育不良患者在中期和长期随访中PROs有显著改善。中期随访时的生存率为98.2%（328/334例髋关节），长期随访时为76.3%（29/38例髋关节）。
证据水平
IV级，对III级和IV级研究的系统评价。
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