Utility of Intra-articular Hip Injections for Femoroacetabular Impingement: A Systematic Review.
Utility of Intra-articular Hip Injections for Femoroacetabular Impingement: A Systematic Review.
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DOI：
10.1177/2325967115601030
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发表时间：
2015-09
影响因子：
2.6
通讯作者：
Ayeni OR
中科院分区：
文献类型：
--
作者：
Khan W;Khan M;Alradwan H;Williams R;Simunovic N;Ayeni OR
股骨髋臼撞击（FAI）是一种越来越被认为是运动员、青少年和成人髋关节疼痛的常见病因的疾病。然而，病史和临床检查往往不能确诊，而影像学检查往往发现无症状的异常。传统上，治疗仅限于手术，保守治疗的作用仍不清楚。探讨髋关节内注射在FAI诊断和治疗中的应用价值。系统评价;证据等级，4级。对MEDLINE、EMBASE和PubMed数据库中1946年1月至2014年1月期间发表的研究进行了一式两份的筛选。检索词包括股骨髋臼撞击、髋关节撞击和关节内注射。使用非随机研究方法学索引（MINORS）量表对所有纳入研究进行质量评估。评价的数据包括研究设计、研究目的、髋关节数量、注射产品、疼痛缓解持续时间和测量的结局。我们的检索产生了8项研究，涉及281例髋关节。研究分为诊断（4项研究）、治疗（3项研究）和预后（1项研究）应用。有FAI及其退行性后遗症的患者，诊断性髋关节内注射比无FAI的患者获得更大的缓解（P <0.05）。超声引导下进行的诊断性关节内注射比荧光镜引导下进行的注射耐受性更好（疼痛评分，5.6 vs 3.0; P < .1）。关节内注射透明质酸在缓解疼痛方面最有效（23例患者），12个月时功能结局指标（Harris髋关节评分，视觉模拟量表）显著改善。皮质类固醇注射的汇总结果在6周时仅15%（9/60）的患者得到改善。对髋关节内注射的阴性反应是不良手术结局的强预测因子。本综述的结果表明：（1）髋关节内注射获得的疼痛缓解支持FAI的诊断;（2）12个月时可以实现治疗缓解，特别是使用透明质酸;（3）术前注射的阴性反应可能预示短期手术结局不佳。需要更多的大型研究来建立在本综述中包含的少量研究的基础上，并进一步描述关节内髋关节注射在治疗FAI中的作用。
Femoroacetabular impingement (FAI) is a condition that is becoming increasingly recognized as a common etiology of hip pain in athletes, adolescents, and adults. However, history and clinical examination are often inconclusive in reaching a diagnosis, while imaging often detects asymptomatic abnormalities. Treatment has traditionally been limited to surgery, with the role of conservative management remaining unclear. To evaluate the utility of the intra-articular hip injection in the diagnosis and management of FAI. Systematic review; Level of evidence, 4. MEDLINE, EMBASE, and PubMed databases were screened in duplicate for studies published between January 1946 and January 2014. Search terms included femoroacetabular impingement, hip impingement, and intra-articular injection. Quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) scale was completed for all included studies. Data evaluated included study design, study objectives, number of hips, injected product, duration of pain relief, and outcomes measured. Our search yielded 8 studies involving 281 hips. Studies were categorized into diagnostic (4 studies), therapeutic (3 studies), and prognostic (1 study) applications. Patients with FAI and its degenerative sequelae obtained greater relief from diagnostic intra-articular hip injection than those without (P < .05). The diagnostic intra-articular injection performed under ultrasound guidance was better tolerated than injections performed under fluoroscopic guidance (pain rating, 5.6 vs 3.0; P < .1). Intra-articular injection of hyaluronic acid was the most effective at providing pain relief (in 23 patients), with significant improvements of functional outcome measures (Harris Hip Score, visual analog scale) present at 12 months. Pooled results with corticosteroid injection resulted in improvement in only 15% (9/60) of patients at 6 weeks. A negative response to intra-articular hip injection was a strong predictor for poor surgical outcomes. The results of this review suggest that (1) pain relief obtained from an intra-articular hip injection supports a diagnosis of FAI, (2) therapeutic relief at 12 months may be achieved, particularly with hyaluronic acid, and (3) a negative response to preoperative injections may predict poor short-term surgical outcomes. Additional large studies are required to build on the small number of studies included in this review, and further delineate the role of intra-articular hip injection in the management of FAI.