股骨髋臼撞击综合征患者术后渗出-滑膜炎与临床疗效不佳有关:一项连续磁共振成像研究。

IF 4.4 1区 医学 Q1 ORTHOPEDICS
Yichuan Zhu, Hongli Wang, Kesheng Wu, Shuo Luan, Yanni Zhang, Guanying Gao, Yan Xu
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引用次数: 0

摘要

目的:(1)研究股骨髋臼撞击综合征(FAIS)患者在接受初次关节镜治疗后积液-鞘膜炎的连续变化;(2)确定术后积液-鞘膜炎对临床疗效的影响:方法:回顾 2021 年 3 月至 2022 年 1 月期间的数据。方法:回顾 2021 年 3 月至 2022 年 1 月期间的数据,纳入确诊为 FAIS 并接受髋关节镜治疗的患者。排除标准为磁共振成像(MRI)数据不完整、既往髋关节手术史、唇瓣重建术以及并发髋关节疾病。术前、术后3个月、6个月、12个月进行核磁共振成像(非对比3.0 T),并收集股骨颈积液最大厚度(FTM)和积液-滑膜炎横截面积(CSA)的测量数据。收集并比较术前和术后至少两年的患者报告结果(PRO)评分,包括视觉模拟疼痛量表(VAS)、改良哈里斯髋关节评分(mHHS)和国际髋关节结果工具 12 要素表(iHOT-12)。此外,还收集了术后泰格纳活动量表。比较了有术后渗出-滑膜炎和无术后渗出-滑膜炎患者的PROs和最小临床重要差异(MCID)及患者可接受症状状态(PASS)。进行了多变量线性回归分析,以确定渗出-滑膜炎大小对PROs的影响:研究共纳入了61名患者(61个髋关节)。与术前相比,术后 3 个月的 FTM、CSA 和渗出-滑膜炎分级均有显著增加(均为 P <.05)。术后 6 个月的测量结果与术前相比无明显差异(均为 P > .05)。在 12 个月的随访中,虽然所有测量值与术前值相比都有显著下降(均为 P < .001),但仍有 39 名患者(63.9%)出现了渗出性滑膜炎。与其他 22 例(36.1%)无流出液-滑膜炎的患者相比,这些患者的 mHHS 和 iHOT-12 均较差(均为 P <.05),mHHS(82.1% vs 100%,P = .035)和 iHOT-12 (38.5% vs 81.8%,P = .001)的 PASS 值也较低。mHHS(79.5% vs 77.3%,P = .839)和iHOT-12(89.7% vs 95.5%,P = .839)的MCID达标率在有渗出-滑膜炎和无渗出-滑膜炎患者之间相当。在回归分析中,术后矢状面CSA(Beta = -.302, P = .039)与mHHS呈负相关:结论:关节镜治疗 FAIS 后,渗出-滑膜炎的水平最初会升高,随后会降低。与术前水平相比,12 个月后渗出性滑膜炎明显减轻。与没有渗出性滑膜炎的患者相比,术后有渗出性滑膜炎的患者临床疗效较差,PASS的达标率也较低:证据级别:IV级;回顾性病例系列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postoperative Effusion-Synovitis Is Associated With Poor Clinical Outcomes in Patients With Femoroacetabular Impingement Syndrome.

Purpose: To investigate the consecutive changes in effusion-synovitis after primary arthroscopic treatment for patients with femoroacetabular impingement syndrome (FAIS) and to determine the effect of postoperative effusion-synovitis on clinical outcomes.

Methods: Data from March 2021 through January 2022 was reviewed. Patients diagnosed with FAIS and undergoing hip arthroscopic treatment were included. Exclusion criteria were incomplete magnetic resonance imaging (MRI) data, prior history of hip surgery, labral reconstruction, and concomitant hip conditions. MRI (noncontrast 3.0 T) was performed preoperatively and 3, 6, and 12 months postoperatively, and the measurement of the largest femoral neck fluid thickness (FTM) and cross-sectional area (CSA) of the effusion-synovitis were collected. Preoperative and a minimum of 2-year postoperative patient-reported outcome (PRO) scores including visual analog scale (VAS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool, 12-component form (iHOT-12) were collected and compared. Postoperative Tegner Activity Scale was also collected. The PROs and achievements of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared between patients with and without postoperative effusion-synovitis. Multivariate linear regression analysis was performed to determine the effect of the effusion-synovitis size on PROs.

Results: A total of 61 patients (61 hips) were included in the study. The 3-month postoperative FTM, CSA, and grade of effusion-synovitis presented a significant increase compared with the preoperative values (all P < .05). No significant differences were observed in the 6-month postoperative measurements compared with the preoperative values (all P > .05). At the 12-month follow-up, although there was a significant decrease in all measurements compared with the preoperative values (all P < .001), 39 patients (63.9%) still presented effusion-synovitis. Compared with the other 22 patients (36.1%) without effusion-synovitis, these patients presented inferior mHHS, iHOT-12 (all P < .05), as well as lower achievement of PASS of mHHS (82.1% vs 100%, P = .035) and iHOT-12 (38.5% vs 81.8%, P = .001). The achievement of MCID of mHHS (79.5% vs 77.3%, P = .839) and iHOT-12 (89.7% vs 95.5%, P = .839) were comparable between patients with and without effusion-synovitis. The postoperative sagittal CSA (beta = -.302, P = .039) were negatively related to mHHS in the regression analysis.

Conclusions: After arthroscopic treatment for FAIS, the level of effusion-synovitis presented an initial increase, then followed by a subsequent decrease. Effusion-synovitis was significantly alleviated at 12 months compared with the preoperative level. Patients with postoperative effusion-synovitis had inferior clinical outcomes and lower achievement of PASS compared to those without.

Level of evidence: Level IV, retrospective case series.

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来源期刊
CiteScore
9.30
自引率
17.00%
发文量
555
审稿时长
58 days
期刊介绍: Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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