目的:通过分析生存率和PROs,系统评价髋关节软骨损伤的关节保留手术的结果。
方法:从2018年至2023年5月,使用PRISMA指南在三个数据库中进行了文献检索:PubMed,Embase,谷歌学者。如果他们报告了接受髋关节镜检查治疗髋关节软骨损伤的患者的结果,以及是否有可量化的术后结果指标,则纳入研究。使用MINORS标准完成质量评估。
结果:纳入27项研究,有20项非比较研究和7项比较研究。微骨折(MFx)是最常见的手术,在17项研究中报道。其他程序包括自体软骨细胞移植(ACT)(五项研究),自体基质诱导的软骨形成(AMIC)(三项研究),MFx与CarGel结合(三项研究)。在单独的独立研究中报告了其他七个新程序。存活率,定义为最新随访时未进行翻修手术或转换为THA,对于MFx(14项研究),AMIC(3项研究),MFx与CarGel(3项研究)的结合范围为59.1%至100%,92.9%至100%,和94.4%到95.7%,分别。ACT的存活率,生物重建,清创和磨损,微碎裂自体脂肪组织移植,和软骨填充凝胶在单独的研究中都报告了一次,比率为100%,100%,85.4%,100%,92.3%,分别。所有研究都包括专业人员,在最近的随访中,大多数报告有统计学意义的改善(P<0.05)。
结论:隔离MFx仍然是最常用的技术,然而,与2018年之前的研究相比,生存率较低,THA转化率较高。与MFx联合进行或完全避免MFx的新技术具有较高的总体生存率,尽管执行最少。所有技术中的大多数患者在PRO方面表现出显著的改善。
方法:四级,系统评价III级和IV级研究。
OBJECTIVE: To systematically
review outcomes of joint preservation procedures for chondral lesions of the hip through analysis of survival rates and patient-reported outcomes (PROs).
METHODS: A literature search from 2018 to May 2023 was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in 3 databases: PubMed, Embase, and Google Scholar. Studies were included if they reported on outcomes of patients undergoing hip arthroscopy for the treatment of chondral lesions of the hip joint and if there were quantifiable postoperative outcome measures. Quality assessment was completed using the Methodological Index for Non-Randomized Studies criteria.
RESULTS: Twenty-seven studies were included, with 20 noncomparative and 7 comparative studies. Microfracture (MFx) was the most common procedure, reported in 17 studies. Other procedures include autologous chondrocyte transplantation (ACT) (5 studies), autologous matrix-induced chondrogenesis (AMIC) (3 studies), and MFx in conjunction with CarGel (3 studies). Seven other novel procedures were reported in individual separate studies. Survival rates, defined by no revision surgery or conversion to total hip arthroscopy (THA) at latest follow-up, for MFx (14 studies), AMIC (3 studies), and MFx in conjunction with CarGel (3 studies) ranged from 59.1% to 100%, 92.9% to 100%, and 94.4% to 95.7%, respectively. Survival rates of ACT, biological reconstruction, debridement and abrasion, microfragmented autologous adipose tissue transplantation, and ChondroFiller gel were all reported once in separate studies with rates of 100%, 100%, 85.4%, 100%, and 92.3%, respectively. All studies included PROs, most reporting statistically significant improvements (P < .05) at the latest follow-up.
CONCLUSIONS: Isolated MFx remained the most commonly performed technique, but with lower survival and higher conversion to THA rates than in studies before 2018. Novel techniques that were performed in conjunction with MFx or that avoided MFx altogether had higher overall survival rates despite being minimally performed. Most patients across all techniques demonstrated significant improvements in PROs.
METHODS: Level IV, systematic
review of Level III and IV studies.