镜下与开放手术治疗股骨髋臼撞击症的荟萃分析

Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement: a meta-analysis

摘要:

［目的］比较关节镜和开放性手术治疗股骨髋臼撞击症（femoroacetabular impingement, FAI）的临床疗效。［方法］检索中国知网、中国生物医学文献、万方、维普、PubMed、Embase、web of science 和 Cochrane 图书馆数据库自建库至 2021 年 4 月 30 日的文献，收集关节镜与开放性手术治疗 FAI 疗效对比的临床研究。文献检索、数据提取和质量评估均由 2 名独立评审员使用 Cochrane 5.1 风险偏倚，同时通过 RevMan 5.3 软件整合分析各个研究的观察指标进行荟萃分析。［结果］ 最终纳入 8 篇文献，涉及 862 例患者，其中，关节镜组 427 例，开放性手术组 435 例。荟萃分析结果显示：关节镜组在治疗 3 个月后的 NAHS 评分、治疗 3 个月后的 HOS-ADL 评分和并发症发生率均显著优于开放性手术组 （P<0.05）；但治疗 12 个月后，两组 NAHS 评分、HOS-ADL 评分、mHHS 评分、HOS-SSS 评分、HNO 和改变的 α 角的差异均无统计学意义（P>0.05）。［结论］关节镜和开放性手术治疗 FAI 均可取得良好的临床疗效，但关节镜治疗在并发症发生率和治疗初期的疗效方面较开放性手术组有明显优势，NAHS 和 HOS-ADL 评分显著增高。

Abstract:

[Objective] To compare the clinical efficacy of hip arthroscopy versus open surgery in the treatment of femoroacetabular im- pingement (FAI) . [Methods] The literatures of CNKI, Chinese Biomedical literature, Wanfang, VIP, PubMed, Embase, Web of Science and the Cochrane Library database were searched until April 30, 2021. The clinical study on comparison between hip arthroscopy and open sur- gery for FAI was collected. The quality assessment and then data extraction were conducted by two independent reviewers using Cochrane 5.1 risk bias software for the literatures searched, and an meta-analysis was conducted with RevMan 5.3 software by integrating the observa- tional items of each study. [Results] A total of 8 articles were included, involving 862 patients, including 427 patients in the arthroscopy group and 435 patients in the open group. As results of meta-analysis, the arthroscopy group proved significantly superior to the open group in terms of Non- arthritic Hip Score (NAHS) , Hip Outcome Score-Activities of Daily Living (HOS-ADL) , and complication rate at 3 months postoperatively (P＜0.05) . However, there were no significant differences in NAHS score, HOS-ADL score, Modified Harris Hip Score (mHHS) , Hip Outcome Score-Sport Specific Subscale (HOS-SSS) , femoral head-neck offset (HNO) and α angle between the two groups at 12 months postoperatively (P＞0.05) . [Conclusion] Both hip arthroscopy and open surgery do achieve satisfactory clinical out- comes for FAI, by comparison, hip arthroscopy takes obvious advantages over open surgery in the incidence of complications and initial treatment efficacy in term of NAHS and HOS-ADL scores.