Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China.
Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China.
Arthroscopy. 2023 Jun;39(6):1454-1461. doi: 10.1016/j.arthro.2023.01.024. Epub 2023 Feb 2.
To evaluate the changes in anterior hip capsular thickness on pre- and postoperative magnetic resonance imaging (MRI) and their associated clinical outcomes in patients with borderline developmental dysplasia of the hip (BDDH).
A minimum 2-year follow-up retrospective analysis was performed using data from symptomatic patients with BDDH who underwent hip arthroscopy with routine capsular closure between 2018 and 2020. An available postoperative hip MRI was a prerequisite for study inclusion. Capsular thickness at the capsulotomy zone was measured on MRI. An analysis of the correlations between anterior capsular thickness differences and demographic factors (including age, sex, body mass index, laterality, preoperative alpha angle and lateral center-edge angle, cartilage lesion grade, follow-up time, and capsule management) was performed. Patients with unhealed or partially healed capsules (study group) were propensity-score matched 1:1 to patients with completely healed capsules based on age, sex, body mass index, and follow-up time. Comparisons and analyses of the following parameters were completed for both groups: patient-reported outcomes (Hip Outcome Score-Activities of Daily Living [HOS-ADL], Hip Outcome Score-Sports-Specific Subscale [HOS-SSS], International Hip Outcome Tool 12-component form [iHOT-12], and modified Harris Hip Score), visual analog scale scores, radiographic measures, performed procedures, and complications.
Data were compiled for 59 patients' hips after patient selection. The majority of the repaired hip capsules remained closed (93.2%) at a minimum 2-year follow-up. Propensity-score matching was applied to distribute 25 subjects in the study group and 25 in the control group. The anterior capsule was significantly thinner postoperation in the study group (3.0 ± 1.2 mm vs 4.1 ± 0.6 mm; P < .001). Compared with the control group, patients in the study group had significantly inferior postoperative HOS-ADL (75.1 vs 83.5, P = .007), HOS-SSS (64.5 vs 77.1, P = .005), and iHOT-12 scores (56.1 vs 70.2, P = .006). In addition, patients in the study group were significantly less likely to achieve the minimum clinically important difference for the HOS-ADL score (52% vs 80%, P = .037) score and patient acceptable symptomatic state for the HOS-ADL score (32% vs 60%, P = .047).
The majority of the repaired hip capsules in patients with BDDH remained closed but not all capsules completely healed at a minimum 2-year follow-up. Patients with an unhealed or partially healed capsule had inferior HOS-ADL, HOS-SSS, and iHOT-12 scores and were less likely to achieve the minimum clinically important difference and patient acceptable symptomatic state for the HOS-ADL score.
III, retrospective comparative prognostic study.
评估髋关节镜下常规闭合术治疗边界型髋关节发育不良（BDDH）患者的术前和术后磁共振成像（MRI）中髋关节前囊厚度的变化及其与临床结果的相关性。
回顾性分析 2018 年至 2020 年间接受髋关节镜下常规闭合术治疗的有症状的 BDDH 患者的资料，纳入标准为有术后髋关节 MRI 随访资料。在 MRI 上测量关节囊切开区的囊厚度。分析囊厚度差异与年龄、性别、体质量指数、侧别、术前 α 角和外侧中心边缘角、软骨损伤分级、随访时间和关节囊处理等因素的相关性。根据年龄、性别、体质量指数和随访时间，将未愈合或部分愈合的关节囊（研究组）与完全愈合的关节囊（对照组）进行 1:1 倾向评分匹配。比较并分析两组患者的髋关节功能：髋关节评分（日常生活活动评分 HOS-ADL、髋关节特异性评分 HOS-SSS、国际髋关节评分 12 项量表 iHOT-12 和改良 Harris 髋关节评分）、视觉模拟评分（VAS）、影像学测量、手术操作和并发症。
经过患者选择，59 例髋关节的数据被纳入研究。在至少 2 年的随访中，大多数修复的髋关节囊保持闭合（93.2%）。对 25 例研究组和 25 例对照组患者进行了倾向评分匹配。研究组术后关节囊明显变薄（3.0 ± 1.2 mm 比 4.1 ± 0.6 mm；P <.001）。与对照组相比，研究组患者术后 HOS-ADL（75.1 比 83.5，P <.001）、HOS-SSS（64.5 比 77.1，P <.001）和 iHOT-12 评分（56.1 比 70.2，P <.001）均显著下降。此外，研究组患者达到 HOS-ADL 评分最小临床重要差异（52%比 80%，P =.037）和 HOS-ADL 评分患者可接受的症状状态（32%比 60%，P =.047）的可能性明显较低。
BDDH 患者的大多数修复髋关节囊在至少 2 年的随访中保持闭合，但并非所有的髋关节囊均完全愈合。未愈合或部分愈合的关节囊患者的 HOS-ADL、HOS-SSS 和 iHOT-12 评分较低，达到 HOS-ADL 评分最小临床重要差异和患者可接受的症状状态的可能性较小。
III 级，回顾性比较预后研究。
