肥胖 I 级延迟了患者可接受症状状态的实现，但在初次髋关节镜治疗股骨髋臼撞击综合征后，并未延迟最小临床重要差异或显著临床获益的实现。
Reprint of: Class I Obesity Delays Achievement of Patient-Acceptable Symptom State but Not Minimum Clinically Important Difference or Substantial Clinical Benefit After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome.
机构信息
Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.
Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
出版信息
Arthroscopy. 2023 Sep;39(9):1971-1979. doi: 10.1016/j.arthro.2023.06.028.
PURPOSE
To identify differences in the time taken to achieve the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different body mass index (BMI) categories.
METHODS
We conducted a retrospective comparative study of hip arthroscopy patients with minimum 2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight (25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative. MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2 and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement of each milestone was compared using the interval-censored EMICM algorithm. The effect of BMI was adjusted for age and sex using an interval-censored proportional hazards model.
RESULTS
285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight, and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P = .006) and at 2-year follow-up (P = .008). There were no significant intergroup differences in time to achievement for MCID (P = .92) or SCB (P = .69), but obese patients had longer time to PASS than normal BMI patients (P = .047). Multivariable analysis found obesity to be predictive of longer time to PASS (HR = .55; P = .007) but not MCID (HR = 0.91; P = .68) or SCB (HR = 1.06; P = .30).
CONCLUSIONS
Class I obesity is associated with delays in achieving a literature-defined PASS threshold after primary hip arthroscopy for FAIS.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
确定不同身体质量指数（BMI）类别患者接受髋关节镜治疗股骨髋臼撞击综合征（FAIS）后达到最小临床重要差异（MCID）、显著临床获益（SCB）和患者可接受症状状态（PASS）的时间差异。
方法
我们对至少随访 2 年的髋关节镜患者进行了回顾性比较研究。BMI 类别定义为正常（18.5≤BMI<25.0）、超重（25.0≤BMI<30.0）或 I 级肥胖（30.0≤BMI<35.0）。所有患者在术前和术后 6 个月、1 年和 2 年均完成改良 Harris 髋关节评分（mHHS）。MCID 和 SCB 截定点定义为 mHHS 术前到术后的增加分别为≥8.2 和≥19.8。PASS 截定点设定为术后 mHHS≥74。使用间隔censored EMICM 算法比较达到每个里程碑的时间。使用间隔 censored 比例风险模型，根据年龄和性别调整 BMI 的影响。
结果
285 例患者纳入分析：150 例（52.6%）为正常 BMI，99 例（34.7%）为超重，36 例（12.6%）为肥胖。肥胖患者基线时（P=0.006）和 2 年随访时（P=0.008）的 mHHS 较低。在达到 MCID（P=0.92）或 SCB（P=0.69）的时间方面，各组间无显著差异，但肥胖患者达到 PASS 的时间长于正常 BMI 患者（P=0.047）。多变量分析发现肥胖与 PASS 时间延长有关（HR=0.55；P=0.007），但与 MCID（HR=0.91；P=0.68）或 SCB（HR=1.06；P=0.30）无关。
结论
I 级肥胖与接受髋关节镜治疗 FAIS 后达到文献定义的 PASS 阈值的时间延迟有关。
证据等级
III 级，回顾性比较研究。
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