Ebert Jay R, Raymond Antony C, Aujla Randeep S, D'Alessandro Peter
School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Australia.
HFRC Rehabilitation Clinic, Nedlands, Australia.
Am J Sports Med. 2023 Mar;51(3):694-706. doi: 10.1177/03635465221148744. Epub 2023 Feb 8.
Although the initial treatment recommendations for femoroacetabular impingement syndrome (FAIS) may include nonsurgical therapies such as injections and rehabilitation, many patients undergo isolated injections or a rudimentary exercise regimen.
To investigate the benefit of an intra-articular hip injection and concomitant structured exercise rehabilitation program in patients with symptomatic FAIS ≥6 months.
Case series; Level of evidence, 4.
For this study we recruited 49 patients with a mean age of 32.8 years (range, 16-56 years) and symptoms ≥6 months (range, 6-250 months) associated with FAIS, as confirmed via magnetic resonance imaging and radiography. After a guided intra-articular injection of corticosteroid and local anesthetic, patients underwent a structured 12-week rehabilitation program. Patients were assessed before and after injection (8 weeks and 4, 6, 12, and 24 months) with a range of patient-reported outcome measures (PROMs), including the 33-item International Hip Outcome Tool, Hip Outcome Score, modified Harris Hip Score, the Tegner Activity Score, a visual analog scale assessing the frequency and severity of hip pain, and a Global Rating of Change scale. Range of motion, peak isometric hip strength, and hop tests were assessed. Absolute scores and limb symmetry indices were calculated. The percentage of patients transitioning toward surgery over the period was evaluated.
Of the 44 patients who underwent the injection and completed the initial 8-week rehabilitation component, 14 (31.8%) progressed toward surgical intervention over the 24-month postinjection period owing to dissatisfaction and/or symptom recurrence. Patients who progressed toward surgery, as compared with those who did not, reported significantly worse ( < .05) PROMs presurgery and more pain within the first 4 weeks after injection. In the nonoperative cohort, a significant improvement ( < .05) in all PROMs was observed, with 93% of these patients satisfied overall. The Global Rating of Change did not improve, although this was measured only after the injection, reflecting no further significant perceived global change from 8 weeks to 24 months. A significant increase ( < .05) in all hip range of motion and most isometric strength measures was observed at 8 weeks after injection, with these improvements largely sustained until 24 months. Bilateral improvements in hop capacity were observed, with hop test LSIs significantly improving for the single ( = 0.009), triple ( = 0.029) and triple crossover ( = 0.005) hop tests for distance.
Although 32% of patients progressed toward surgery, significant improvement in hip pain, symptoms, and physical function was observed in the majority of patients with symptomatic FAIS as a result of a targeted nonoperative management pathway consisting of an intra-articular injection and a structured exercise program.
尽管针对股骨髋臼撞击综合征（FAIS）的初始治疗建议可能包括注射和康复等非手术疗法，但许多患者仅接受了注射或基本的锻炼方案。
研究关节内髋关节注射联合结构化运动康复计划对症状持续≥6个月的FAIS患者的益处。
病例系列；证据等级，4级。
本研究招募了49例平均年龄为32.8岁（范围16 - 56岁）且症状持续≥6个月（范围6 - 250个月）的FAIS患者，经磁共振成像和X线摄影确诊。在关节内注射皮质类固醇和局部麻醉剂的引导下，患者接受了为期12周的结构化康复计划。在注射前以及注射后8周、4个月、6个月、12个月和24个月对患者进行评估，采用一系列患者报告的结局指标（PROMs），包括33项国际髋关节结局工具、髋关节结局评分、改良Harris髋关节评分、Tegner活动评分、评估髋关节疼痛频率和严重程度的视觉模拟量表以及整体变化评分量表。评估关节活动范围、等长髋关节峰值力量和跳跃测试。计算绝对分数和肢体对称性指数。评估在此期间接受手术治疗的患者百分比。
在44例接受注射并完成初始8周康复部分的患者中，14例（31.8%）在注射后24个月内由于不满意和/或症状复发而接受了手术干预。与未接受手术的患者相比，接受手术的患者术前报告的PROMs明显更差（P <.05），且注射后前4周疼痛更严重。在非手术队列中，所有PROMs均有显著改善（P <.05），其中93%的患者总体满意。尽管整体变化评分仅在注射后进行测量，反映从8周到24个月没有进一步明显的整体感知变化，但该评分没有改善。注射后8周观察到所有髋关节活动范围和大多数等长力量测量值均有显著增加（P <.05），这些改善在很大程度上持续到24个月。观察到跳跃能力的双侧改善，单腿（P = 0.009）、双腿（P = 0.029）和双腿交叉（P = 0.005）跳跃测试的跳跃测试肢体对称性指数显著改善。
尽管32%的患者接受了手术治疗，但通过由关节内注射和结构化运动计划组成的针对性非手术管理途径，大多数有症状的FAIS患者的髋关节疼痛、症状和身体功能有显著改善。
