保髋截骨治疗髋关节发育不良(5)：40岁以上患者髋臼周围截骨术疗效最新研究进展

保髋截骨治疗髋关节发育不良(5)：40岁以上患者髋臼周围截骨术疗效最新研究进展

作者：Kyle P O‘Connor, Deniz J Ince, John C Clohisy, Michael C Willey.

作者单位: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.

译者：陶可（北京大学人民医院骨关节科）

摘要

背景：髋关节发育不良是髋关节骨关节炎的主要原因。虽然髋臼周围截骨术(PAO)可有效缓解青少年和年轻人髋关节发育不良引起的疼痛和功能障碍，但人们担心40岁以上的患者持续出现功能障碍和需要全髋关节置换术的风险会增加。目前关于老年人PAO的证据有限，文献中没有针对这一主题的系统综述。当前的系统综述深入了解了40岁以上接受PAO治疗髋关节发育不良的患者的人口统计学、患者报告结果测量(PROM)评分和全髋关节置换术的髋关节存活率。

方法：该综述是根据系统综述和荟萃分析的首选报告项目(PRISMA)指南进行的。搜索的数据库包括PubMed、OVID Medline、SCOPUS、Embase、Cochrane Library和clinicaltrials.gov。根据预先确定的纳入和排除标准对研究进行筛选。

结果：本系统评价纳入了5项研究。入组年份为1990-2013年。总共有335个髋关节，平均年龄在43.5-47.2岁之间。平均随访时间为4-10.8年。大多数接受髋关节保留手术治疗的患者Tonnis骨关节炎等级为0-1级。有相互矛盾的证据提示40岁以上的患者与40岁以下的患者相比临床疗效优劣；尽管40岁以上的患者中的大多数患者在PAO后都有良好的结果。PAO存活率根据研究不同在67-100%之间。并发症根据研究不同在2-36%之间；尽管这些并发症都没有持久影响。

结论：40岁以上的患者接受PAO治疗髋关节发育不良似乎能取得积极效果，尽管这些患者可能是因为没有或仅有轻微骨关节炎、功能状态良好且健康状况良好而被选中的。对于40岁以上无髋关节炎的髋关节发育不良患者，应考虑接受PAO治疗，但我们建议有严格的适应症。

Hip Dysplasia Treated With Periacetabular Osteotomy in Patients Over 40 Years Old: A Systematic Review

Abstract

Background: Hip dysplasia is a leading cause of hip osteoarthritis. While periacetabular osteotomy (PAO) is effective for relieving pain and dysfunction caused by hip dysplasia in adolescents and young adults, there is concern that patients over 40 years of age will have an increased risk of persistent dysfunction and need for total hip arthroplasty. Current available evidence for PAO in older adults is limited and there is no systematic review in the literature focusing on this topic. The current systematic review offers insight into the demographics, patient-reported outcome measure (PROM) scores, and hip survivorship from total hip arthroplasty in patients over 40 years older treated for hip dysplasia with PAO.

Methods: The review was conducted under the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Databases that were searched included PubMed, OVID Medline, SCOPUS, Embase, Cochrane Library, and clinicaltrials.gov. Studies were screened based on predetermined inclusion and exclusion criteria.

Results: Five studies were included in this systematic review. Enrollment years were 1990-2013. In total, there were 335 hips with mean ages between 43.5-47.2 years. Mean follow up was 4-10.8 years. Most patients that underwent hip preservation had Tonnis osteoarthritis grade 0-1. There was contradicting evidence whether patients ＞40 years did better or worse compared to ＜40 years; although, most patients in the ＞40 years group had good outcomes after PAO. PAO survivorship ranged from 67-100% depending on the study. Complications ranged from 2-36% of cases depending on the study; although, none of these complications had lasting effects.

Conclusion: Patients over 40 years old appear to have positive outcomes when treated for hip dysplasia with PAO, though these patients were likely selected for no to minimal osteoarthritis, high functional status, and good health. PAO should be considered for patients with hip dysplasia over 40 years old without hip arthritis, though we recommend very selective indications.

文献出处：Kyle P O‘Connor, Deniz J Ince, John C Clohisy, Michael C Willey. Hip Dysplasia Treated With Periacetabular Osteotomy in Patients Over 40 Years Old: A Systematic Review. Review, Iowa Orthop J. 2024;44(1):105-112.