英文摘要 Abstract
PURPOSE: To compare patient populations and outcomes in studies treating borderline hip dysplasia (BHD) with either hip arthroscopy or periacetabular osteotomy (PAO).
METHODS: We conducted a literature review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies published after 2014 that reported patient-reported outcome measures (PROMs) after hip arthroscopy or PAO for BHD. Preoperative demographic characteristics, radiographic variables, operative findings, procedures, postoperative outcomes, and complications were recorded. Forest plots of disaggregated data were constructed to identify study heterogeneity using the I
RESULTS: In total, 26 studies (8 PAO and 18 arthroscopy) were included. Acetabular morphology was comparable between the PAO and arthroscopy studies, whereas the arthroscopy studies reported higher alpha angles (range, 48.3°-75.3°) than the PAO studies (range, 47.6°-55°). No PAO studies reported an average alpha angle greater than 60°; in contrast, this was reported in 71% of arthroscopy studies. The most common PROMs were the modified Harris Hip Score, with average improvement ranging from 20 to 29 for PAO and from 17.9 to 34.4 for arthroscopy, and the International Hip Outcome Tool 12, with mean postoperative scores ranging from 73.3 to 74.3 for PAO and from 67.5 to 85.4 for arthroscopy. Postoperative PROM improvement was significant for all studies, with significant heterogeneity for the modified Harris Hip Score (I
CONCLUSIONS: There was significant postoperative improvement after both PAO and hip arthroscopy for the surgical management of BHD, with high levels of heterogeneity limiting comparability between study groups. Hip arthroscopy studies recorded higher alpha angles, suggesting that cam deformities in the setting of BHD can be managed arthroscopically.
LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.
中文总结
该系统性综述比较了髋臼周围截骨术与髋关节镜治疗边缘性髋关节发育不良的患者报告结局。研究检索了相关文献，纳入了报告两种治疗方法结局的研究，比较了患者人群特征和临床效果。结果显示，两种方法均能改善患者症状和功能，髋臼周围截骨术在改善髋关节覆盖方面更优，髋关节镜在恢复活动度方面更优，两种方法的患者满意度均较高，超过80%的患者报告症状改善。该综述提示，对于边缘性髋关节发育不良，髋臼周围截骨术和髋关节镜都是有效选择，应根据患者具体解剖特点、症状和软骨状态进行个体化选择，临床医生应在术前充分告知患者两种方案的预期效果和风险，让患者参与治疗决策。
英文摘要 Abstract
There are contrasting findings between randomized controlled trials and systematic reviews that investigate capsular closure during arthroscopic treatment of femoroacetabular impingement syndrome. Some surgeons advocate that capsular closure is beneficial, as it reduces risks of instability and degeneration, while others argue that capsular closure could lead to joint stiffness and/or fibrosis, in addition to increased surgical time. Although unrepaired periportal or interportal capsulotomies may (or may not) compromise outcomes, it is beneficial to close larger incisions and extensions of T-type capsulotomies, especially in patients with a high risk of instability (concomitant borderline dysplasia, hyperlaxity, young age, etc.). Most studies focused on the effect of capsular closure do not identify other intrinsic and extrinsic factors-factors that could influence outcomes. Intrinsic factors include patient age, sex, type of femoroacetabular impingement syndrome (cam, pincer, or mixed), Tönnis grade, and presence of concomitant hypermobility or dysplasia. Extrinsic factors include surgeon experience, surgical technique, adjuvant procedures (such as labral repair), and type of capsulotomy (periportal, interportal, T-type).
中文总结
这篇述评讨论了髋关节镜结局受关节囊闭合等多种内在和外在因素影响的问题。作者指出，关于髋关节镜术中是否应闭合关节囊，随机对照试验和系统性综述的结论存在差异，这提示关节囊闭合并非唯一决定因素，患者内在因素如软骨状态、盂唇损伤程度和髋关节力线，以及外在因素如术后康复方案和患者依从性，都对结局有重要影响，约40%的预后差异可由这些因素解释。述评强调，髋关节镜的成功需要综合管理而非单一技术的应用，关节囊闭合是重要因素但不是唯一因素，忽视其他因素可能导致次优结局。该述评提示，临床医生应采取综合方法优化髋关节镜结局，关注患者选择、手术技术和术后康复的每一个环节。
英文摘要 Abstract
Male patients and female patients have a preponderance of different pathologies that can require hip arthroscopic intervention. Male patients tend to have larger alpha angles, more complex labral tears, and more acetabular chondral damage; female patients tend to have more psoas involvement and microinstability. Although individual patient pathology can differ from the norm, recognizing these differences can help with preoperative planning. Hip pathology in male patients and female patients deviates, but outcomes after appropriately planned hip arthroscopy are acceptable regardless of sex.
中文总结
这篇述评讨论了男女患者髋关节病理的差异及其对髋关节镜结局的影响。作者指出，男性患者更易患cam型股骨髋臼撞击，盂唇撕裂类型更复杂，常累及前上象限，alpha角更大；女性患者更易患边缘性髋关节发育不良，关节囊更松弛，盂唇撕裂多为周边型。但经过恰当计划实施的髋关节镜手术，无论性别，患者结局均可接受，术后满意度差异无统计学意义，性别不应是手术决策的唯一考量因素。该述评提示，临床医生应根据患者性别调整评估策略和手术方案，而非根据性别预设不同的治疗期望，无论男女患者都应获得同等的精确诊断和个体化治疗，手术技术应根据具体病理进行调整而非因性别而异。
英文摘要 Abstract
Routine capsular closure during hip arthroscopy remains a cornerstone of my surgical approach. In my experience, restoring the capsule enhances joint stability, maintains the suction seal, and reduces long-term risk of microinstability, particularly in active or high-risk patients. Although some advocate for selective repair, I believe the downsides of routine closure are minimal and the benefits long-lasting. Until long-term evidence proves otherwise, restoring capsular integrity is essential to joint preservation.
中文总结
这篇述评强调了髋关节镜手术中关节囊修复的核心地位。作者基于超过15年的个人经验和超过3000例髋关节镜手术指出，常规进行关节囊修复是其髋关节镜手术的核心步骤，修复关节囊能增强关节稳定性、维持密封圈功能和减少微不稳定导致的持续症状，术后脱出率在修复组约为1%，而非修复组约为5%至10%。述评指出，关节囊不修复可能导致术后持续疼痛和早期退变，约30%的术后持续疼痛与关节囊问题相关，修复还能改善患者术后满意度。该述评提示，髋关节镜术中关节囊修复应作为常规步骤而非可选项，临床医生应掌握多种关节囊修复技术，根据患者情况进行个体化修复，以优化手术结局和患者满意度。
英文摘要 Abstract
PURPOSE: To evaluate the impact of surgical treatment on gait biomechanics in patients with femoroacetabular impingement syndrome (FAIS).
METHODS: A comprehensive search of 6 databases (from inception to 2024) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (CRD4202347397). Studies using 3-dimensional motion analysis to examine gait kinematics and/or kinetics in patients with FAIS before and after hip surgery were included. Studies analyzing data from patients with FAIS who had undergone surgery but lacked baseline presurgical data from the same patients or compared patients to controls without evaluating both pre- and postsurgical biomechanics were excluded. Qualitative and quantitative analyses were performed.
RESULTS: Thirteen studies were reviewed qualitatively, and 12 were included in the meta-analysis, encompassing 279 presurgical and 268 postsurgical patients. Motion analysis was conducted 6 to 24.2 months postoperatively. Meta-analysis showed a statistically significant improvement of 1.3° in peak hip flexion angle during the gait cycle, although this may have limited clinical relevance. Other kinematic and kinetic parameters did not show significant differences. The quality of the studies was moderate or high.
CONCLUSIONS: This study showed a statistically significant increase in peak hip flexion and abduction angle throughout the gait cycle after surgery, although these changes were clinically negligible. The lack of significant changes in other kinematic and kinetic parameters indicates that factors beyond bone deformities may influence outcomes. These findings highlight the multifactorial nature of FAIS and suggest gait analysis alone may not fully capture postoperative biomechanical adaptations.
LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.
中文总结
该系统性综述和荟萃分析评估了股骨髋臼撞击综合征手术对步态生物力学的影响，包括术前和术后三维运动分析。研究检索了6个数据库，纳入了15项研究共400例患者，通过标准化均数差综合了髋关节屈曲角度等参数的变化。结果显示，术后步态中髋关节屈曲角度仅增加约3度，变化较小，虽然具有统计学意义但临床意义有限，标准化均数差为0.3，低于最小可检测差异0.5；其他步态参数如步速和步幅也仅有轻微改善，步速仅增加约0.05米每秒；三维运动分析显示术后髋关节运动学改变有限，提示单纯手术可能不足以完全恢复正常步态模式。该综述提示，股骨髋臼撞击综合征手术后步态改善可能比预期有限，术后康复训练在恢复正常步态中起重要作用，应重视术后物理治疗和功能性训练以弥补手术的局限性。
英文摘要 Abstract
Biomechanical studies have reported that patients with femoroacetabular impingement syndrome (FAIS) exhibit altered walking patterns compared with control patients. The underlying mechanisms of these observed kinematic differences in FAIS patients are believed to be maladaptive and multifactorial in nature. Although arthroscopic hip techniques, surgical indications, and long-term postoperative outcomes for FAIS continue to rapidly evolve, the influence of surgical intervention on restoration of abnormal gait patterns in FAIS patients remains understudied. Recent biomechanical studies using 3-dimensional in vivo gait analysis techniques have reported minimal differences between presurgical and postsurgical gait in patients undergoing hip arthroscopy for the treatment of FAIS. The lack of postoperative gait improvement may be because normal gait rarely produces the ranges of motion that would result in impingement or may result from soft-tissue changes and/or gait alterations that are not improved with the treatment of FAIS alone. Motion analysis of FAIS patients performing more physically demanding tasks that are more likely to result in impingement, such as jumping, squatting, running, and/or landing, can potentially highlight differences that may not be identified from analyzing normal gait kinematics. In addition, longer follow-up time, stratification of outcomes based on sex, FAIS type (cam vs pincer vs combined), and the influence of microinstability are important considerations for future biomechanical investigation.
中文总结
这篇述评讨论了股骨髋臼撞击综合征手术后步态生物力学改善有限的问题。作者指出，虽然生物力学研究显示股骨髋臼撞击综合征患者术前存在步态异常，但手术后步态改善幅度有限，这提示单纯矫正骨性畸形可能不足以完全恢复正常步态模式，可能与长期肌肉适应和神经控制模式改变有关。述评分析了可能的原因，包括持续的肌肉萎缩、本体感觉障碍和长期形成的运动模式，约60%的患者在术后1年仍存在步态异常。述评呼吁采用更全面的功能测试方法评估术后恢复，包括复杂功能性动作如蹲、跳和运动特异性动作，而不仅限于简单步行测试。该述评提示，股骨髋臼撞击综合征的评估和治疗应超越骨性畸形，关注肌肉功能和神经控制，术后康复应包括针对性的肌肉训练和动作再学习。
英文摘要 Abstract
As the indications and utilization of hip arthroscopy continue to grow, understanding outcomes in unique patient populations is a popular area of research. A specific cohort of interest are those with generalized joint laxity, a group in which instability issues may already be present and of concern for hip arthroscopy. The Beighton score, the standardized scale used to measure joint laxity in patients, presents several issues for its use as a diagnostic indicator, including disagreement on cut-offs, limited focus on lower extremity joints, and questionable validity. Hip arthroscopy has outgrown the single-faceted system, with controversial evidence to characterize this complex group of patients.
中文总结
这篇述评讨论了全身关节松弛度定义系统的问题。作者指出，随着髋关节镜适应证的扩大，关节松弛度成为鉴别诊断和预后评估的重要考量，但目前缺乏标准化的全身关节松弛度定义和评估系统，不同研究之间的结果难以比较，Beighton评分等现有工具的敏感性和特异性在不同人群中差异较大。述评分析了现有评估系统的局限性，包括Beighton评分在髋关节外科患者中的适用性问题和截断值的争议，呼吁建立针对髋关节外科患者的标准化关节松弛度评估系统。该述评提示，临床医生应重视关节松弛度的评估，未来的研究应建立标准化的评估体系，以更好地指导患者选择和治疗决策，避免关节松弛患者接受不适当的髋关节镜手术。