Arthroscopic Debridement Versus Refixation of the Acetabular Labrum Associated With Femoroacetabular Impingement Mean 3.5-Year Follow-up
Arthroscopic Debridement Versus Refixation of the Acetabular Labrum Associated With Femoroacetabular Impingement Mean 3.5-Year Follow-up
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DOI：
10.1177/0363546511434578
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发表时间：
2012-05-01
影响因子：
4.8
通讯作者：
Stone, Rebecca M.
中科院分区：
文献类型：
--
作者：
Larson, Christopher M.;Giveans, M. Russell;Stone, Rebecca M.
背景：髋臼唇提供封闭功能和一定程度的髋关节稳定性。有限的短期随访研究表明，与唇部清创/切除相比，唇部再固定/保留具有更好的结果。目的：比较一组接受关节镜矫正股骨髋臼撞击（FAI）患者的唇部再固定与局灶性唇部切除/清创的结果。研究设计：队列研究；证据水平，3。方法：我们报道了在唇瓣修复技术发展之前接受唇瓣清创/局灶性唇瓣切除的患者。我们将目前关节镜技术认为可修复的唇裂患者与一组接受唇部再固定的患者进行比较。为了更好地匹配两组，仅纳入唇钳型或混合型FAI患者。在前44个髋关节中，局部切除/清除阴唇（组1）；在接下来的50髋中，对唇部进行复位（第二组）。采用改进的Harris髋关节评分（HHS）、SF-12短表（SF-12）和视觉模拟量表（VAS）对术前和术后疼痛进行测量。术前和术后x线片评估骨切除。结果：1组患者平均年龄32岁，2组患者平均年龄28岁，平均随访42个月（范围24 ~ 72个月）。术前平均主观结局评分组间无显著差异。在平均3.5年的随访中，两组患者的主观预后与术前评分相比均有显著改善（P < 0.01）。在最近的随访中，再固定组的HHS （P = .001）、SF-12 （P = .041）和VAS疼痛评分（P = .004）均明显优于清创组。在平均3.5年的随访中，68%的局灶切除/清创组和92%的再固定组的结果良好至优异（P = 0.004）。结论：尽管其他因素可能会影响这些结果，但在平均3.5年的随访中，与早期局灶性唇部切除/清创队列相比，唇部再固定可获得更好的HHS、SF-12和VAS疼痛结局，良好至优异结果的百分比更高。
Background: The acetabular labrum provides a sealing function and a degree of hip joint stability. Limited, short-term follow-up studies suggest that labral refixation/preservation leads to superior outcomes compared with labral debridement/excision.Purpose: To compare the results of labral refixation versus focal labral excision/debridement in a cohort of patients who underwent arthroscopic correction of femoroacetabular impingement (FAI).Study Design: Cohort study; Level of evidence, 3.Methods: We reported on patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. Patients with labral tears thought to be repairable with our current arthroscopic technique were compared with a cohort of patients who underwent labral refixation. To better match the 2 groups, only patients with labral pincer- or combined-type FAI were included. In the first 44 hips, the labrum was focally excised/debrided (group 1); in the next 50 hips, the labrum was refixed (group 2). Outcomes were measured with the modified Harris Hip Score (HHS), Short Form 12 (SF-12), and a visual analog scale (VAS) for pain preoperatively and postoperatively. Preoperative and postoperative radiographs were obtained to evaluate bony resection.Results: The mean age was 32 years in group 1 and 28 years in group 2 with a mean follow-up of 42 months (range, 24-72 months). Preoperative mean subjective outcome scores were not significantly different between groups. At a mean 3.5 years' follow-up, subjective outcomes were significantly improved (P < .01) for both groups compared with preoperative scores. The HHS (P = .001), SF-12 (P = .041), and VAS pain scores (P = .004) were all significantly better for the refixation group compared with the debridement group at the most recent follow-up. At a mean 3.5 years' follow-up, good to excellent results were noted in 68% of the focal excision/debridement group and 92% of the refixation group (P = .004).Conclusion: Although other factors may have influenced these results, labral refixation compared with an earlier cohort of focal labral excision/debridement resulted in better HHS, SF-12, and VAS pain outcomes and a greater percentage of good to excellent results at a mean 3.5-year follow-up.