J Orthop Sports Phys Ther. 2023 May;53(5):286–306. doi: 10.2519/jospt.2023.11666.
We aimed to (1) determine the rate of satisfactory response to nonoperative treatment for nonarthritic hip-related pain, and (2) evaluate the specific effect of various elements of physical therapy and nonoperative treatment options aside from physical therapy. Systematic review with meta-analysis. We searched 7 databases and reference lists of eligible studies from their inception to February 2022. We included randomized controlled trials and prospective cohort studies that compared a nonoperative management protocol to any other treatment for patients with femoroacetabular impingement syndrome, acetabular dysplasia, acetabular labral tear, and/or nonarthritic hip pain not otherwise specified. We used random-effects meta-analyses, as appropriate. Study quality was assessed using an adapted Downs and Black checklist. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Twenty-six studies (1153 patients) were eligible for qualitative synthesis, and 16 were included in the meta-analysis. Moderate certainty evidence suggests that the overall response rate to nonoperative treatment was 54% (95% confidence interval: 32%, 76%). The overall mean improvement after physical therapy treatment was 11.3 points (7.6-14.9) on 100-point patient-reported hip symptom measures (low to moderate certainty) and 22.2 points (4.6-39.9) on 100-point pain severity measures (low certainty). No definitive specific effect was observed regarding therapy duration or approach (ie, flexibility exercise, movement pattern training, and/or mobilization) (very low to low certainty). Very low to low certainty evidence supported viscosupplementation, corticosteroid injection, and a supportive brace. Over half of patients with nonarthritic hip-related pain reported satisfactory response to nonoperative treatment. However, the essential elements of comprehensive nonoperative treatment remain unclear. .
（1）确定非关节炎性髋关节相关疼痛的非手术治疗满意度反应率，以及（2）评估除物理治疗外，物理治疗和各种非手术治疗选择的各个要素的具体效果。系统评价与荟萃分析。我们检索了 7 个数据库和符合条件研究的参考文献列表，检索时间从研究开始至 2022 年 2 月。我们纳入了比较非手术治疗方案与任何其他治疗方法的随机对照试验和前瞻性队列研究，这些研究的对象为股骨髋臼撞击综合征、髋臼发育不良、髋臼盂唇撕裂以及/或非特异性髋关节疼痛的患者。我们根据需要使用了随机效应荟萃分析。使用改良的 Downs 和 Black 清单评估研究质量。使用推荐评估、制定与评价分级（GRADE）方法评估证据的确定性。26 项研究（1153 名患者）适合进行定性综合，其中 16 项研究被纳入荟萃分析。中等确定性证据表明，非手术治疗的总体反应率为 54%（95%置信区间：32%，76%）。在 100 分患者报告的髋关节症状量表上（低到中等确定性），物理治疗后的总体平均改善程度为 11.3 分（7.6-14.9），在 100 分疼痛严重程度量表上（低确定性）为 22.2 分（4.6-39.9）。关于治疗持续时间或方法（即灵活性练习、运动模式训练和/或松动术），没有观察到明确的具体效果（非常低到低确定性）。非常低到低确定性证据支持黏弹性补充剂、皮质类固醇注射和支撑性支具。超过一半的非关节炎性髋关节相关疼痛患者对非手术治疗有满意的反应。然而，全面非手术治疗的基本要素仍不清楚。
