髋关节镜检查和髋臼周围截骨术联合治疗的最低 2 年随访结果显示功能改善。

Improved Functional Outcomes of Combined Hip Arthroscopy and Periacetabular Osteotomy at Minimum 2-Year Follow-Up.

机构信息

Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A.

Steadman Philippon Research Institute, Vail, Colorado, U.S.A.

出版信息

Arthroscopy. 2024 Feb;40(2):352-358. doi: 10.1016/j.arthro.2023.06.034. Epub 2023 Jun 30.

DOI:10.1016/j.arthro.2023.06.034

PMID:37392802

Abstract

PURPOSE

To evaluate patient-reported outcomes (PROs) and survivorship at minimum 2-year follow-up after combined hip arthroscopy and periacetabular osteotomy (PAO) performed in the setting of a single anesthetic event.

METHODS

Patients who underwent combined hip arthroscopy (M.J.P.) and PAO (J.M.M.) between January 2017 and June 2020 were identified. Preoperative and minimum 2-year postoperative PROs including Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sport, modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Osteoarthritis Index, 12-Item Short Form Survey Mental Component Scores (SF-12 MCS), and 12-Item Short Form Survey Physical Component Score were collected and compared in addition to revision rate, conversion to total hip arthroplasty (THA), and patient satisfaction.

RESULTS

Twenty-four of 29 patients (83%) eligible for the study were available for 2-year minimum follow-up with a median follow-up time of 2.5 years (range, 2.0-5.0). There were 19 females and 5 males with mean age of 31 ± 12 years. Mean preoperative lateral center edge angle was 20° ± 5° and alpha angle was 71° ± 11°. One patient underwent reoperation for removal of a symptomatic iliac crest screw at 11.7 months after operation. Two patients, a 33-year-old woman and a 37-year-old man, were converted to THA at 2.6 and 1.3 years, respectively, following the combined procedure. Both patients had a Tönnis grade of 1 on radiographs, as well as bipolar Outerbridge grade III/IV defects requiring microfracture of the acetabulum. For patients who did not convert to THA (n = 22), there was significant improvement from before to after surgery for all scores (P < .05) except SF-12 MCS. The minimal clinically significant difference and patient-acceptable symptom state rates for HOS-ADL, HOS-Sport, and mHHS were 72%, 82%, 86%, and 95%, 91%, and 95%, respectively. Median patient satisfaction was 10 (range, 4 to 10).

CONCLUSIONS

Single-stage combined hip arthroscopy with periacetabular osteotomy for patients with symptomatic hip dysplasia results in improvement in PROs and arthroplasty free survivorship of 92% at median 2.5 year follow-up.

LEVEL OF EVIDENCE

Level IV, case series.

摘要

目的

评估在单次麻醉下进行髋关节镜检查和髋臼周围截骨术（PAO）治疗后至少 2 年的患者报告结局（PRO）和存活率。

方法

确定了 2017 年 1 月至 2020 年 6 月期间接受联合髋关节镜检查（MJP）和 PAO（JMM）的患者。收集了术前和至少 2 年的术后 PRO，包括髋关节功能评分-日常生活活动（HOS-ADL）、髋关节功能评分-运动（HOS-Sport）、改良 Harris 髋关节评分（mHHS）、西部安大略省和麦克马斯特大学骨关节炎指数、12 项简明健康调查心理成分评分（SF-12 MCS），以及 12 项简明健康调查身体成分评分，并比较了翻修率、全髋关节置换术（THA）转换率和患者满意度。

结果

29 名符合研究条件的患者中有 24 名（83%）可进行至少 2 年的最低随访，中位随访时间为 2.5 年（范围，2.0-5.0 年）。其中有 19 名女性和 5 名男性，平均年龄为 31±12 岁。术前外侧中心边缘角平均为 20°±5°，α角为 71°±11°。1 名患者在术后 11.7 个月因症状性髂嵴螺钉而再次手术。2 名患者，1 名 33 岁女性和 1 名 37 岁男性，分别在联合手术后 2.6 年和 1.3 年转换为 THA。这两名患者的 Tönnis 分级均为 1 级，且髋臼存在双极 Outerbridge III/IV 级病变，需要进行髋臼微骨折。对于未转换为 THA 的患者（n=22），所有评分在术前和术后均有显著改善（P<.05），除了 SF-12 MCS。HOS-ADL、HOS-Sport 和 mHHS 的最小临床显著差异和患者可接受症状状态率分别为 72%、82%、86%和 95%、91%和 95%。中位患者满意度为 10（范围，4 到 10）。