Patients With Borderline Hip Dysplasia Achieve Clinically Significant Improvement After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With a Minimum 5-Year Follow-up
Patients With Borderline Hip Dysplasia Achieve Clinically Significant Improvement After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With a Minimum 5-Year Follow-up
复制标题
DOI：
10.1177/0363546520916473
复制
发表时间：
2020-05-14
影响因子：
4.8
通讯作者：
Nho, Shane J.
中科院分区：
文献类型：
--
作者：
Beck, Edward C.;Drager, Justin;Nho, Shane J.
背景：髋关节镜手术治疗交界性髋关节发育不良（BHD）患者的股骨髋臼撞击综合征（FAIS）正变得越来越普遍。然而，关于在中期随访中实现有意义的结果以及这些结果的预测因素的文献有限。目的：(1) 比较患有和不患有 BHD 的患者之间实现有意义的临床结果的比率，以及 (2) 确定 BHD 患者在接受 FAIS 髋关节镜手术 5 年后实现临床成功的预测因素。证据级别3。方法：收集2012年1月至2014年8月期间接受初次髋关节镜手术并常规囊膜闭合治疗FAIS的连续患者的数据并进行回顾性分析。 BHD 患者（侧中心边缘角 [LCEA] 20 度 - 25 度）按年龄（+/- 1 岁）和体重指数（BMI；+/- 5 kg/m(2)）以 1:2 进行匹配，以控制髋臼覆盖正常的患者（LCEA 25 度 - 40 度）。收集的数据包括基线和术后 5 年患者报告的结果。计算每个患者报告的结果测量的最小临床重要差异（MCID）和患者可接受的症状状态（PASS），并在两组之间进行比较。使用二元逻辑回归分析来确定 BHD 组中实现 MCID 和 PASS 的显着预测因素。 结果：BHD 组中的 MCID 定义为髋关节结果评分 - 日常生活活动、髋关节结果评分 - 运动子量表和修正的 Harris 髋关节评分分别为 9.6、14.1 和 9.5。两组达到 PASS 的阈值分别为 90.9、76.6 和 81.9。共有 88 名患者被确定患有 BHD，并与 176 名对照者进行匹配。年龄、体重指数或性别没有发现统计差异。 5 年期间，BHD 组和非 BHD 组患者报告的结果评分均有统计学显着增加，但两组之间的差异并不具有统计学显着性（全部 P > 0.05）。 BHD 组和非 BHD 组患者在至少 1 项结果测量中达到 MCID（分别为 86.6% 与 85.2%；P = .804）或 PASS（分别为 76.0% 与 73.7%；P = .675）的患者频率没有统计学差异。逻辑回归模型表明，身体活动（比值比 [OR]，27.59；P = .005）和女性（OR，14.64；P = .025）是实现 MCID 的独立预测因素，而跑步（OR，11.1；P = .002）、女性（OR，7.6；P = .011）和较大的术前 LCEA（OR， 2.3；P = .001）是实现 PASS 的独立术前预测因素。 结论：接受关节镜下 FAIS 关节囊闭合治疗后 5 年，BHD 患者与髋臼覆盖正常的患者之间获得临床成功的比率没有显着差异。身体活跃、跑步锻炼、女性和较大的 LCEA 是 BHD 患者 5 年取得临床成功的术前预测因素。
Background:Hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD) is becoming a more common practice. However, the literature on achieving meaningful outcomes at midterm follow-up, as well as predictors of these outcomes, is limited.Purpose:To (1) compare the rates of achieving meaningful clinical outcomes between patients with and without BHD and (2) identify the predictors for achieving clinical success among patients with BHD 5 years after undergoing hip arthroscopic surgery for FAIS.Study Design:Cohort study; Level of evidence, 3.Methods:Data from consecutive patients who underwent primary hip arthroscopic surgery with routine capsular closure for the treatment of FAIS between January 2012 and August 2014 were collected and retrospectively analyzed. Patients with BHD (lateral center-edge angle [LCEA] 20 degrees-25 degrees) were matched 1:2 by age (+/- 1 year) and body mass index (BMI; +/- 5 kg/m(2)) to control patients with normal acetabular coverage (LCEA 25 degrees-40 degrees). Data collected included baseline and 5-year postoperative patient-reported outcomes. The minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for each patient-reported outcome measure and compared between the 2 groups. A binary logistic regression analysis was used to identify significant predictors of achieving the MCID and PASS in the BHD group.Results:The MCID in the BHD group was defined as 9.6, 14.1, and 9.5 for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, and modified Harris Hip Score, respectively. Threshold scores for achieving the PASS in both groups were 90.9, 76.6, and 81.9, respectively. A total of 88 patients were identified with having BHD and were matched to 176 controls. No statistical differences were identified for age, BMI, or sex. Both the BHD and the non-BHD groups had statistically significant increases in patient-reported outcome scores over the 5-year period, but the difference in both groups was not statistically significant (P > .05 for all). There was no statistical difference in the frequency of patients in the BHD and non-BHD groups achieving the MCID (86.6% vs 85.2%, respectively; P = .804) or PASS (76.0% vs 73.7%, respectively; P = .675) on at least 1 outcome measure. The logistic regression model demonstrated that being physically active (odds ratio [OR], 27.59; P = .005) and being female (OR, 14.64; P = .025) were independent predictors of achieving the MCID, while running (OR, 11.1; P = .002), being female (OR, 7.6; P = .011), and a larger preoperative LCEA (OR, 2.3; P = .001) were independent preoperative predictors of achieving the PASS.Conclusion:The rates of achieving clinical success 5 years after undergoing arthroscopic treatment with capsular closure for FAIS were not significantly different between patients with BHD and those with normal acetabular coverage. Being physically active, running for exercise, female sex, and a larger LCEA were preoperative predictors of achieving clinical success at 5 years in patients with BHD.