延迟诊断是常见的髋关节保留手术候选人：系统回顾

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-08-01 DOI:10.1016/j.asmr.2025.101155

Karter Morris B.S. , Jaydeep Dhillon D.O. , Carson Keeter M.S. , Matthew J. Kraeutler M.D.

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引用次数: 0

摘要

目的系统回顾有关髋关节保留患者诊断或治疗延误的文献。方法通过检索PubMed、Cochrane Library和Embase数据库，从成立之日起至2024年11月，进行系统回顾，以确定任何报告髋关节保留患者诊断或治疗延迟的研究，即患有股髋臼撞击综合征、髋关节发育不良或股扭转异常的患者。使用的搜索词如下：延迟和（诊断或治疗）和（“股髋臼撞击”或“髋关节发育不良”或“髋关节镜检查”或“髋臼周围截骨术”）。报告的结局包括人口学特征、术前症状持续时间和患者报告的结局。结果12篇文章符合纳入标准，其中ⅱ级1篇，ⅲ级1篇，ⅳ级10篇，共计2883髋。患者的平均年龄为16.4 ~ 45.0岁，男性患者的总体比例为0% ~ 56.9%。所有研究中，髋关节保留患者从症状出现到准确诊断的平均时间为17.2至61.5个月。先前咨询的卫生保健提供者主要是其他骨科医生和初级保健医生；每位患者平均咨询1.9至4.2名医生，并接受了大量的替代诊断、影像学评估和治疗尝试，然后才向髋关节保护专家就诊。在比较症状持续时间短和持续时间长的患者（分别为1年和2年）的结果的研究中，在症状持续时间较长的组中，观察到术后患者报告的结果明显较差。结论髋关节保留病变患者通常会出现诊断和/或治疗延迟的情况，在接受准确的诊断和适当的治疗之前，需要咨询不同专业的多个医疗保健提供者。反过来，与及时接受适当治疗的患者相比，这导致治疗后结果较差。证据等级：IV级，对II至IV级研究的系统评价。

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Delays in Diagnosis Are Common Among Hip Preservation Surgical Candidates: A Systematic Review

Purpose

To systematically review the literature on delays in diagnosis or treatment of hip preservation patients.

Methods

A systematic review was performed by searching PubMed, the Cochrane Library, and Embase, from inception to November 2024, to identify any study reporting on delays in diagnosis or treatment of hip preservation patients, that is, patients with femoroacetabular impingement syndrome, hip dysplasia, or femoral torsion abnormalities. The search terms used were as follows: delay AND (diagnosis OR treatment) AND ("femoroacetabular impingement" OR "hip dysplasia" OR "hip arthroscopy" OR "periacetabular osteotomy"). Outcomes reported included demographic characteristics, preoperative duration of symptoms, and patient-reported outcomes.

Results

Twelve articles (1 Level II, 1 Level III, and 10 Level IV) met the inclusion criteria, with a total of 2,883 hips. The mean patient age ranged from 16.4 to 45.0 years, and the overall percentage of male patients ranged from 0% to 56.9%. The mean time from symptom onset to accurate diagnosis for hip preservation patients ranged from 17.2 to 61.5 months across studies. Prior health care providers consulted were largely other orthopaedic surgeons and primary care physicians; each patient consulted with an average of 1.9 to 4.2 providers and received a multitude of alternate diagnoses, imaging assessments, and treatment attempts before presentation to a hip preservation specialist. In studies comparing outcomes between patients with short and long durations of symptoms (i.e., <2 years and >2 years, respectively), significantly worse postoperative patient-reported outcomes were observed in the groups with a longer symptom duration.

Conclusions

Patients presenting with hip preservation pathologies commonly experience delays in diagnosis and/or treatment and consult with multiple health care providers across specialties before receiving an accurate diagnosis and appropriate treatment. In turn, this leads to poorer post-treatment outcomes compared with patients who receive appropriate treatment in a timely manner.