Does Arthroscopic FAI Correction Improve Function with Radiographic Arthritis?
Does Arthroscopic FAI Correction Improve Function with Radiographic Arthritis?
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DOI：
10.1007/s11999-010-1741-6
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发表时间：
2011-06-01
影响因子：
4.2
通讯作者：
Taylor, Mehul
中科院分区：
文献类型：
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作者：
Larson, Christopher M.;Giveans, M. Russell;Taylor, Mehul
以前的研究报告骨关节炎（OA）对髋关节镜术后疼痛和功能的影响主要发生在股骨髋臼撞击（FAI）切除术之前。我们确定了（1）术前放射学关节间隙狭窄患者FAI撞击病变切除术后的功能改善，（2）确定了疼痛、功能、在2004年9月至2008年4月期间，我们对210例患者（227髋）进行了FAI治疗，并进行了至少12个月（平均27个月）的随访。FAI组包括154例（169髋）无影像学关节间隙狭窄的患者，而FAI-OA组包括56例（58髋）术前影像学关节间隙狭窄的患者。我们在术前和术后收集了Harris髋关节评分（HHS）、简明健康调查表（SF-12）和视觉模拟量表（VAS）疼痛评分，FAI组的评分改善优于FAI-OA组。FAI-OA组的总体失败率（52%）高于FAI组（12%）。尽管术前X线片显示关节间隙狭窄小于50%或关节间隙大于2 mm的患者在整个研究期间评分有所改善，但我们在任何时间均未观察到晚期术前关节间隙狭窄的评分改善。关节间隙变窄程度越大、MRI软骨分级越高、术前症状持续时间越长，则预测评分越低。FAI矫正与术前影像学关节间隙变窄程度越轻，短期随访时疼痛和功能改善越明显。影像学上关节间隙严重狭窄的患者没有改善，我们认为不应该考虑关节镜下FAI矫正。IV级，预后研究。有关证据等级的完整描述，请参见作者指南。
Previous studies reporting the impact of osteoarthritis (OA) on pain and function after hip arthroscopy largely predate resection of femoroacetabular impingement (FAI).We determined (1) functional improvement after resection of FAI impingement lesions in patients with preoperative radiographic joint space narrowing, and (2) identified preoperative predictors of pain, function, and failure rates in these patients.Between September 2004 and April 2008, we treated 210 patients (227 hips) with FAI and a minimum 12-month followup (mean, 27 months). Group FAI consisted of 154 patients (169 hips) without radiographic joint space narrowing, whereas Group FAI-OA consisted of 56 patients (58 hips) with preoperative radiographic joint space narrowing. We collected Harris hip scores (HHS), Short Form-12 (SF-12), and pain scores on a visual analog scale (VAS) preoperatively and postoperatively.Score improvements were better for Group FAI compared with Group FAI-OA. The overall failure rate was greater for Group FAI-OA (52%) than for Group FAI (12%). Although patients with less than 50% joint space narrowing or greater than 2 mm joint space remaining on preoperative radiographs had improved scores throughout the study, we observed no score improvements at any time with advanced preoperative joint space narrowing. Greater joint space narrowing, advanced MRI chondral grade, and longer duration of preoperative symptoms predicted lower scores.FAI correction with milder degrees of preoperative radiographic joint space narrowing resulted in improvements in pain and function at short-term followup. Patients with advanced radiographic joint space narrowing do not improve and we believe should not be considered for arthroscopic FAI correction.Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.