Return to Play After Periacetabular Osteotomy for Treatment of Acetabular Dysplasia in Adolescent and Young Adult Athletes
Return to Play After Periacetabular Osteotomy for Treatment of Acetabular Dysplasia in Adolescent and Young Adult Athletes
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DOI：
10.1177/0363546516632743
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发表时间：
2016-06-01
影响因子：
4.8
通讯作者：
Kim, Young-jo
中科院分区：
文献类型：
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作者：
Heyworth, Benton E.;Novais, Eduardo N.;Kim, Young-jo
背景：Bernese髋臼周围截骨术(PAO)是治疗症状性髋臼发育不良的有效手术选择。几乎没有证据表明PAO的结果和运动员的比赛回报率(RTP)。假设：大多数运动员将表现出功能结果的改善，如改良的Harris髋关节评分、髋关节残疾和骨关节炎结果评分，并将能够在PAO后重返运动。研究设计：病例系列；证据水平，4。方法：使用学术转诊中心的全面的髋关节外科数据库来确定接受PAO手术的运动员的亚群。分析的数据包括以前的手术、再手术以及RTP的时间和特征。评估标准的术前和术后放射学参数和有效的功能结果指标，并用回归模型评估延长持续时间的危险因素。结果：在5年研究期间进行的245例PAO中，41例符合运动员入选标准的患者共46例(平均年龄26.2岁；年龄13-41岁；女性36例；占所有PAO的19%)，代表了各种运动项目。既往手术9个髋关节(20%)。在研究期间，只有1例(2%)的患者在PAO后进行了异位骨化切除。在最终的随访中(中位数3.1年；范围1.2-4.4年)，改良的Harris髋关节评分(从71分到90分；P<；.001)和髋关节残疾和骨关节炎结果评分(从到89分；P<；.001)都有显著的改善。加州大学洛杉矶分校活动量表得分维持在较高水平(范围8.0-8.2；P=.28)。术后中位数9个月，80%的患者(37/46)报告了RTP，术后疼痛增加是RTP时间较长的唯一独立预测因素。在这37名运动员中，27名(73%)恢复到相同的水平，尽管这在竞技运动员(11/19；58%)中显著低于休闲运动员(16/18，89%)(P=0.06)。在那些确实恢复到相同水平的运动员中，27名中有23名(85%)能够随着时间的推移维持这一水平，但竞技运动员(8名；73%)和休闲运动员(15名，94%)之间没有显著差异(P=.27)。结论：大多数接受PAO的运动性患者是女性患者，术后功能和恢复运动能力都有所改善。然而，尽管在平均3年的时间里总体活动水平没有下降，但在大约一半的研究人群中达到并保持了自我评估的运动成绩。
Background: The Bernese periacetabular osteotomy (PAO) is an effective surgical treatment option for symptomatic acetabular dysplasia. Little evidence exists regarding the results of PAO and rates of return to play (RTP) in an athletic population.Hypothesis: The majority of athletes will demonstrate improvements in functional outcome measures, such as the modified Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score, and will be able to return to sports after PAO.Study Design: Case series; Level of evidence, 4.Methods: A comprehensive surgical hip database at an academic referral center was used to identify a subpopulation of athletes on whom PAO was performed. Data analyzed included preceding surgeries, reoperations, and RTP timing and features. Standard pre- and postoperative radiologic parameters and validated functional outcome measures were assessed, and a regression model assessed risk factors for prolonged time to RTP.Results: Of 245 PAOs performed over the 5-year study period, 46 were performed in 41 patients who met inclusion criteria for being an athlete (mean age, 26.2 years; range, 13-41 years; 36 females; 19% of all PAOs), representing a variety of sports. Prior surgery had been performed on 9 hips (20%). Only 1 post-PAO procedure (2%), excision of heterotopic ossification, was performed during the study period. At final follow-up (median, 3.1 years; range, 1.2-4.4 years), significant mean improvements were observed in modified Harris Hip Score (from 71 to 90; P < .001) and Hip Disability and Osteoarthritis Outcome Score (from 64 to 89; P < .001). The University of California-Los Angeles Activity Scale scores were maintained at a high level (range, 8.0-8.2; P = .28). RTP was reported in 80% of patients (37 of 46) at a median of 9 months postoperatively, with increased postoperative pain as the only independent predictor of longer time to RTP. Of these 37 athletes, 27 (73%) returned to the same level, although this was significantly less common (P = .06) in competitive athletes (11 of 19; 58%) than in recreational athletes (16 of 18; 89%). Among those who did return at the same level, 23 of 27 (85%) were able to maintain this level over time, but this was not significantly different between competitive (8 of 11; 73%) and recreational (15 of 16; 94%) athletes (P = .27).Conclusion: Most athletic patients undergoing PAO are female patients and show postoperative improvements in function and return to athletic play. However, although there was no decline in overall activity level at a mean of 3 years, self-assessed athletic performance was attained and maintained in approximately one-half of the study population.