Wilson Erin S, Wagner Kyle R, Spiker Andrea M
Department of Orthopedic Surgery, University of Wisconsin - Madison, UW Health at East Madison Hospital, 4602 Eastpark Blvd, Madison, WI, 53718, USA.
Curr Rev Musculoskelet Med. 2024 Dec;17(12):538-547. doi: 10.1007/s12178-024-09928-5. Epub 2024 Sep 28.
As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia.
Current research demonstrates improved postoperative clinical outcome scores for both patients who had isolated hip arthroscopy in the setting of borderline hip dysplasia and for those patients who underwent periacetabular osteotomy. Mid-term outcomes for patients in both groups have showed low rates of conversion to total hip arthroplasty. No gold standard in the surgical management of borderline hip arthroscopy exists. Improved clinical outcomes have been seen postoperatively in patients who undergo hip arthroscopy and in patients who undergo periacetabular osteotomy. Successful clinical outcomes seem to rely on treatment of the underlying clinical pathology and are largely based on the appropriate surgical indications and appropriate surgical techniques. Surgical decision making in this patient population should be individualized based on a comprehensive evaluation of the patient.
随着髋关节保留领域的不断发展，临界发育不良（定义为外侧中心边缘角在18°至25°之间）的诊断已表明是较具挑战性的治疗诊断之一。随着髋臼覆盖细微差别逐渐明了，临界髋关节发育不良是采用单纯髋关节镜检查、髋臼周围截骨术治疗更佳，还是联合手术更佳，这一问题已成为首要考虑。这些手术的目标不仅是改善患者症状，还要纠正潜在病理状况，并理想地减缓髋骨关节炎的发展。本综述的目的是总结近期关于单纯髋关节镜检查和髋臼周围截骨术在临界髋关节发育不良手术治疗方面的文献和临床发现。
当前研究表明，在临界髋关节发育不良情况下接受单纯髋关节镜检查的患者以及接受髋臼周围截骨术的患者，术后临床结果评分均有所改善。两组患者的中期结果显示全髋关节置换术的转换率较低。在临界髋关节镜检查的手术治疗中不存在金标准。接受髋关节镜检查的患者和接受髋臼周围截骨术的患者术后临床结果均有改善。成功的临床结果似乎依赖于对潜在临床病理状况的治疗，并且很大程度上基于适当的手术指征和适当的手术技术。在这一患者群体中，手术决策应基于对患者的全面评估进行个体化制定。
