边缘性发育不良患者髋关节镜手术失败的危险因素包括：Tönnis角≥15°、年龄≥40至42岁、女性、前壁指数<0.35、盂唇清创术以及既往存在髋关节骨关节炎：一项系统评价。
Risk Factors for Failure of Hip Arthroscopy in Patients With Borderline Dysplasia Include a Tönnis Angle ≥15°, Age ≥40 to 42 Years, Female Sex, Anterior Wall Index <0.35, Labral Debridement, and Preexisting Hip Osteoarthritis: A Systematic Review.
作者信息
Kraeutler Matthew J, Terle Preston M, Malempati Mahant, Dhillon Jaydeep, Samuelsson Kristian, Mei-Dan Omer
机构信息
Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center, Lubbock, Texas, U.S.A.; Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, MöIndal, Sweden.
Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
出版信息
Arthroscopy. 2025 Jul;41(7):2636-2645. doi: 10.1016/j.arthro.2024.10.021. Epub 2024 Oct 26.
PURPOSE
To systematically review the literature to determine potential risk factors for failure of hip arthroscopy (HA) in patients with borderline hip dysplasia (BHD).
METHODS
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify English-language clinical studies reporting on patients with BHD undergoing HA from 2003 to 2023. The search terms used were (borderline OR mild) AND hip AND (arthroscopy OR dysplasia) AND failure. The primary outcomes assessed were risk factors reported by each study for failure of a HA-only approach in patients with BHD.
RESULTS
Fourteen studies (8 Level III, 6 Level IV) met inclusion criteria, totaling 749 hips. Patient age ranged from 29.8 to 39.2 years, with a mean follow-up ranging from 24.0 to 144.0 months. The overall percentage of female patients ranged from 11.8% to 100.0%. Overall, the clinical failure rate ranged from 0 to 53.3%, and the reoperation rate ranged from 0 to 44.0%. The predominant predictors of poor outcomes after HA alone included Tönnis angle ≥15°, age ≥40 to 42 years at surgery, and female sex. Other risk factors for failure were preoperative clinical arthritis, grade 3 or 4 articular cartilage changes to the femoral head or acetabulum, an anterior wall index <0.35, and labral debridement. Revision procedures performed included revision HA (n = 88, 0-28.0%), total hip arthroplasty (n = 55, 0%-23.7%), and endoscopic shelf acetabuloplasty (n = 5, 0%-11.0%). One study included an additional 9 patients converting to either periacetabular osteotomy or total hip arthroplasty without distinguishing between the two.
CONCLUSIONS
For patients with BHD, Tönnis angle ≥15°, age ≥40 to 42 years at surgery, female sex, anterior wall index <0.35, labral debridement, and pre-existing hip osteoarthritis are common risk factors for treatment failure following isolated HA.
LEVEL OF EVIDENCE
Level IV, systematic review of Level III-IV studies.
目的
系统回顾文献，以确定临界性髋关节发育不良（BHD）患者髋关节镜检查（HA）失败的潜在风险因素。
方法
根据系统评价和Meta分析的首选报告项目指南进行系统回顾，通过检索PubMed、Cochrane图书馆和Embase，以识别2003年至2023年期间报告BHD患者接受HA的英文临床研究。使用的检索词为（临界性或轻度）且髋关节且（关节镜检查或发育不良）且失败。评估的主要结局是每项研究报告的BHD患者单纯HA治疗失败的风险因素。
结果
14项研究（8项III级，6项IV级）符合纳入标准，共749个髋关节。患者年龄在29.8至39.2岁之间，平均随访时间在24.0至144.0个月之间。女性患者的总体比例在11.8%至100.0%之间。总体而言，临床失败率在0至53.3%之间，再次手术率在0至44.0%之间。单纯HA术后预后不良的主要预测因素包括Tönnis角≥15°、手术时年龄≥40至42岁以及女性性别。其他失败风险因素包括术前临床关节炎、股骨头或髋臼的3级或4级关节软骨改变、前壁指数<0.35以及盂唇清创术。进行的翻修手术包括翻修HA（n = 88，0 - 28.0%）、全髋关节置换术（n = 55，0% - 23.7%）和内镜下髋臼造盖术（n = 5，0% - 11.0%）。一项研究额外纳入了9例转换为髋臼周围截骨术或全髋关节置换术的患者，但未区分两者。
结论
对于BHD患者，Tönnis角≥15°、手术时年龄≥40至42岁、女性性别、前壁指数<0.35、盂唇清创术以及既往存在的髋关节骨关节炎是单纯HA治疗失败的常见风险因素。
证据级别
IV级，III - IV级研究的系统评价。
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