Zhang Jia, Li Chunbao, Zhang Jianping, Zhao Gang, Liu Yujie
Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
Medical School of Chinese PLA, Beijing, China.
Orthop Surg. 2023 Oct;15(10):2665-2673. doi: 10.1111/os.13877. Epub 2023 Aug 29.
Hip arthroscopy for the treatment of symptomatic borderline developmental dysplasia of the hip (BDDH) has been controversial. The purpose of this study was to retrospectively analyze minimum 2-year outcomes of BDDH after arthroscopic surgery and explore the criteria and thresholds of the lateral center-edge angle (LCEA) in arthroscopic surgery for BDDH.
Data were retrospectively collected from patients aged 18-50 who underwent arthroscopic surgery for BDDH and had an LCEA 18-25° between September 2016 and June 2020. The consistency of interobserver and intraobserver measurements of bone-edge LCEA was analyzed. Patients were divided into two groups based on LCEA (18-20°and 20-25°) and the results of arthroscopy compared between groups. Patient-reported outcome (PRO) scores, consisting of the modified Harris hip score (mHHS), the visual analogue scale (VAS) and the international hip outcome tool-12 (IHOT-12), the minimal clinically important difference (MCID) and patient acceptable symptom status (PASS) were calculated.
In 52 patients with ≥2-year follow-up, female patients accounted for 71.2% and the mean age was 30.8 ± 8.4 years (range: 18 to 49 years). There was a high level of agreement when measuring the bone-edge LCEA definition of BDDH (Kappa = 0.921). Interobserver repeatability (ICC = 0.909, 95%CI: 0.847-0.947) and intraobserver repeatability (ICC = 0.944, 95%CI: 0.905-0.968) were excellent for bone-edge LCEA measurements. In addition to LCEA and Tönnis angle, there were no significant differences in α angle, neck stem angle, femoral anteversion angle, medial joint space, Tönnis grade of osteoarthritis, acetabular retroversion (8 sign), Cam deformity and anterior inferior iliac spine (AIIS) morphology between the two groups (p > 0.05). Intraoperative findings and procedures showed no statistical difference between groups (p > 0.05). The mean follow-up time was 44.4 ± 11.0 months (range: 25 to 64 months). Postoperative VAS, mHHS and IHOT-12 scores in the LCEA 18-20° group and the LCEA 20-25° group were significantly improved compared with those before surgery, and there was no statistically significant difference in the percentage of MCID and PASS (mHHS and iHOT-12) between the groups (p > 0.05).
Patients in the LCEA 18-20° group and the LCEA 20-25° group achieved favorable outcomes after arthroscopic surgery. LCEA 18° (bone-edge) should be the threshold for hip arthroscopic surgery in BDDH patients without obvious hip instability.
髋关节镜治疗有症状的临界性发育性髋关节发育不良（BDDH）一直存在争议。本研究的目的是回顾性分析关节镜手术后BDDH至少2年的疗效，并探讨BDDH关节镜手术中外侧中心边缘角（LCEA）的标准和阈值。
回顾性收集2016年9月至2020年6月期间接受BDDH关节镜手术且LCEA为18-25°的18-50岁患者的数据。分析观察者间和观察者内对骨边缘LCEA测量的一致性。根据LCEA（18-20°和20-25°）将患者分为两组，并比较两组间的关节镜检查结果。计算患者报告结局（PRO）评分，包括改良Harris髋关节评分（mHHS）、视觉模拟量表（VAS）和国际髋关节结局工具-12（IHOT-12）、最小临床重要差异（MCID）和患者可接受症状状态（PASS）。
在52例随访≥2年的患者中，女性患者占71.2%，平均年龄为30.8±8.4岁（范围：18至49岁）。在测量BDDH的骨边缘LCEA定义时，一致性较高（Kappa = 0.921）。骨边缘LCEA测量的观察者间重复性（ICC = 0.909，95%CI：0.847-0.947）和观察者内重复性（ICC = 0.944，95%CI：0.905-0.968）极佳。除LCEA和Tönnis角外，两组间α角、颈干角、股骨前倾角、内侧关节间隙、骨关节炎的Tönnis分级、髋臼后倾（8字征）、凸轮畸形和髂前下棘（AIIS）形态无显著差异（p>0.05）。术中发现和操作在两组间无统计学差异（p>0.05）。平均随访时间为44.4±11.0个月（范围：25至64个月）。LCEA 18-20°组和LCEA 20-25°组术后VAS、mHHS和IHOT-12评分较术前显著改善，两组间MCID和PASS（mHHS和iHOT-12）的百分比无统计学差异（p>0.05）。
LCEA 18-20°组和LCEA 20-25°组患者在关节镜手术后取得了良好的疗效。对于无明显髋关节不稳定的BDDH患者，LCEA 18°（骨边缘）应作为髋关节镜手术的阈值。
