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中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 653 -662. doi: 10.3877/cma.j.issn.1674-134X.2023.05.009

荟萃分析

股骨髋臼撞击综合征关节镜手术中闭合关节囊的疗效影响
马鹏程, 刘伟, 张思平†()   
  1. 250000　济南，山东省公共卫生临床中心骨科
    830000　乌鲁木齐，新疆医科大学
    830000　乌鲁木齐，新疆医科大学第四临床医学院
  • 收稿日期:2022-09-19 出版日期:2023-10-01
  • 通信作者: 张思平

Effect of joint capsular closure in arthroscopic treatment for femoroacetabular impingement syndrome

Pengcheng Ma, Wei Liu, Siping Zhang†()   

  1. Department of Orthopedics, Shandong Public Health Clinical Center, Jinan 250000, China
    Xinjiang Medical University, Urumqi 830000, China
    The Fourth Clinical Medical College of Xinjiang Medical University, Urumqi 830000, China
  • Received:2022-09-19 Published:2023-10-01
  • Corresponding author: Siping Zhang
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引用本文：

马鹏程, 刘伟, 张思平. 股骨髋臼撞击综合征关节镜手术中闭合关节囊的疗效影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 653-662.

Pengcheng Ma, Wei Liu, Siping Zhang. Effect of joint capsular closure in arthroscopic treatment for femoroacetabular impingement syndrome[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 653-662.

目的

本研究旨在探究髋关节镜(HA)治疗股骨髋臼撞击综合征(FAIs)术中闭合关节囊对疗效的影响。

方法

对中国知网、万方、维普、PubMed、荷兰医学文摘(Embase)、Web of Science、循证医学图书馆(Cochrane Library)进行检索，文献的纳入标准包括队列研究和随机对照试验(RCTs)、研究对象为初次接受HA治疗的FAIs患者、干预措施为完全闭合关节囊、对照组为不闭合关节囊等。排除标准包括结局指标量化不完整的研究、未完成的研究等。确定纳入文献后进行资料提取，并利用纽卡斯尔－渥太华量表(NOS)评价队列研究的质量，利用改良Jadad量表和Cochrane协作网提供的偏倚风险评价表评价RCTs的质量，使用ReviewManager 5.3软件进行统计分析。

结果

共纳入文献14篇，包括2篇RCTs和12篇队列研究。分析结果显示，与不闭合关节囊组相比，闭合关节囊组的手术时间延长[加权平均差(WMD)＝7.85 min，95%置信区间(CI)(6.40，9.29)，P<0.001]，翻修为全髋关节置换(THA)的概率更低[比值比(OR)＝0.47，95%CI(0.25，0.88)，P＝0.02]，改良Harris髋关节功能评分(MHHS)[WMD＝4.19分，95%CI(2.55，5.82)，P<0.001]、髋关节日常活动功能评分(HOS-ADL)[WMD＝4.98分，95%CI(3.95，6.01)，P<0.001]、髋关节体育运动功能评分(HOS-SSS)[WMD＝3.49分，95%CI(1.57，5.41)，P<0.001]更高，运动能力恢复率也更高[OR＝2.25，95%CI(1.26，4.02)，P＝0.006]，差异均有统计学意义。而两组的并发症率[OR＝0.72，95%CI(0.43，1.22)，P＝0.22]、HA翻修率[OR＝0.72，95%CI(0.49，1.06)，P＝0.10]以及MHHS评分的最小临床重要性差值(MCID)达成率[OR＝1.36，95%CI(0.98，1.89)，P＝0.06]相似，差异均无统计学意义。

结论

闭合关节囊虽然延长了手术时间，但并未增加并发症的发生率。闭合关节囊有助于恢复患者的运动能力以及降低术后翻修为THA的概率，在功能评分方面的总体表现也更好。

关键词: 股骨髋臼撞击征, 关节镜检查, 关节囊, 预后, Meta分析
Objective

To investigate the impact of joint capsule closure in hip arthroscopy (HA) treatment of femorabular impingement syndrome (FAIs).

Methods

China National Knowledge Infrastructure (CNKI), China Online Journals (Wanfang), China Science and Technology Journal Database (VIP), PubMed, Excerpta Medica Database (Embase), Web of Science and Cochrane Library were retrieved. Cohort studies and randomized controlled trials (RCTs) were included. FAIs patients who received HA treatment for the first time were as research participants. The complete joint capsule closure method was the intervention method, while patients who didn’t go through the joint capsule closure method were in the control group. Studies that didn’t contain complete outcome quantification indicators and incomplete studies etc., were excluded. Data extraction was carried out after the literature were identified for inclusion creteria. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of cohort studies. The modified Jadad scale and the risk of bias scale provided by the Cochrane Collaboration were adopted to evaluate the quality of RCTs. ReviewManager 5.3 software was used for statistical analysis.

Results

A total of 14 articles were included, including two RCTs and 12 cohort studies. The results of the analysis showed that compared with the non-joint capsule closure group, the joint capsule closure group had a longer operation time [weighted mean difference (WMD) =7.85 min, 95% confidence interval (CI) (6.40, 9.29), P< 0.001] and lower probability of revision to total hip arthroplasty (THA) [odds ratio (OR) =0.47, 95%CI (0.25, 0.88), P=0.02]. Modified Harris hip score (MHHS) [WMD=4.19, 95%CI (2.55, 5.82), P <0.001], hip outcome score-active of daily living (HOS-ADL) [WMD=4.98, 95%CI(3.95, 6.01)P <0.001], hip outcome score-sports specific subscale (HOS-SSS) [WMD=3.49, 95%CI (1.57, 5.41), P<0.001], and recovery rate of sports ability [OR=2.25, 95%CI (1.26, 4.02), P=0.006)]were higher; the differences were statistically significant. The complication rate of both groups [OR=0.72, 95%CI (0.43, 1.22), P=0.22], re-surgery rate of HA [OR=0.72, 95%CI (0.49, 1.06), P=0.10] and the achievement rate of the minimal clinically important difference (MCID) of MHHS score [OR=1.36, 95%CI (0.98, 1.89), P=0.06] were similar; the differences were not statistically significant.

Conclusions

Although the use of capsule closure prolongs the operation time, it does not increase the incidence of complications. The use of joint capsular closure helps to restore mobility and reduce the probability of revision to THA. The overall performance in functional scores is also better.

Key words: Femoroacetabular impingement, Arthroscopy, Joint capsules, Prognosis, Meta analysis
图1 PubMed检索策略
Figure 1 Search strategy in PubMed
图2 文献纳入流程
Figure 2 Process diagram for included articles
图3 RCTs(随机对照试验)的偏倚风险评价
Figure 3 The risk bias in RCTs
表1 纳入文献的特征
Table 1 Characteristics of the included studies
作者(发表年)/国别Author (year)/Country 研究类型Study design 组别Groups 髋样本量(例)Hips 男/女(例)Male/female 平均年龄(岁)Average age 平均BMI(kg/m2)Average BMI 关节囊切开方式Incision method of capsules 随访时间(个月)Follow-up duration(month) 结局指标Outcomes 文献质量(分)Quality of study
杨伟铭[24] (2022)/中国 队列研究 CC 32 15/17 36.3 NA 入口间切开 6 ①②④⑤ 7
NC 30 14/16 37.8 NA 入口间切开 6
潘廷明[25] (2019)/中国 RCTs CC 30 15/15 37.2 NA T形切开 12 ①④ 5
NC 30 14/16 39.57 NA T形切开 12
曹旭[26] (2022)/中国 队列研究 CC 38 11/27 38.11 24.82 纵行切开 12 ②④⑤⑦ 7
NC 24 11/13 36.58 25.38 纵行切开 12
陈哲峰[27] (2019)中国 队列研究 CC 38 17/21 37.64 21.28 入口间切开 12 ①②④⑤ 7
NC 64 28/36 38.59 21.95 入口间切开 12
耿晓林[28] (2021)/中国 队列研究 CC 28 11/17 35.82 21.54 入口间切开 17.74 ①②④⑤⑦ 7
NC 24 9/15 36.21 21.14 入口间切开 17.74
Jimenez[16] (2022)/美国 队列研究 CC 84 NA 30.1 26.2 入口间切开 41.3 ③④⑤⑥⑦ 7
NC 53 NA 32.1 26.2 入口间切开 36.5
Domb[17] (2018)/美国 队列研究 CC 65 18/47 36.8 24.1 入口间切开 64.8 ②③④⑤⑥ 8
NC 65 18/47 37.7 24.4 入口间切开 75.7
Bolia[18] (2019)/美国 队列研究 CC 84 48/36 38 NA 入口间切开 76.8 ③④⑤ 9
NC 42 24/18 38 NA 入口间切开 87.6
Economopoulos [19](2020)/美国 RCTs CC 50 31/19 35.2 24.8 入口间切开 24 ③④⑤⑥ 5
NC 50 30/20 39.2 26.5 入口间切开 24
Bolia[23](2018)/美国 队列研究 CC 50 27/23 36 NA 入口间切开 60 ③④⑤ 8
NC 50 27/23 36 NA 入口间切开 60
Hassebrock[20](2020)/美国 队列研究 CC 62 44/18 18.6 24.6 入口间切开 24 ②③④⑤⑥⑦ 8
NC 49 32/17 19.4 23.2 入口间切开 24
McGovern[21](2021)/美国 队列研究 CC 68 42/26 29.4 26.1 入口间切开 24 ⑤ 8
NC 60 10/50 33.5 25.2 入口周围切开 24
Thaunat[22](2020)/法国 队列研究 CC 25 4/21 28.5 NA 纵行切开 34.17 ② 7
NC 39 9/30 28.8 NA 纵行切开 34.17
Filan[8](2020)/爱尔兰 队列研究 CC 458 401/57 27.6 NA 入口间切开 30 ①③⑥ 9
NC 508 428/80 28.5 NA 入口间切开 27.6
表2 RCTs文献质量评价(改良Jadad量表)(分)
Table 2 Quality evaluation of RCTs (modified Jadad scale)
作者(发表年)Author (year) Jadad评分
随机序列的产生(共2分)Random sequence generation 组间可比性(共2分)Comparability between groups 盲法(共2分)Blinding 退出与失访(共1分)Withdrawal and loss to follow up 合计Total
潘廷明[25](2019) 2 1 1 1 5
Economopoulos[19](2020) 2 1 1 1 5
表3 队列研究的文献质量评价(分)
Table 3 Articles quality evaluation of cohort study
作者(发表年)Author (year) NOS评分
研究人群的选择(共4分)Selection of people 组间可比性(共2分)Comparability between groups 结果测量(共3分)Outcome measurement 合计Total
杨伟铭[24](2022) 3 2 2 7
曹旭[26](2022) 3 2 2 7
陈哲峰[27](2019) 3 2 2 7
耿晓林[28](2021) 3 2 2 7
Jimenez[16](2022) 3 1 3 7
Domb[17] 2018 4 2 2 8
Bolia[18] 2019 4 2 3 9
Bolia[23] 2018 4 2 2 8
Hassebrock[20](2020) 3 2 3 8
McGovern[21](2021) 4 2 2 8
Thaunat[22](2020) 3 2 2 7
Filan[8](2020) 4 2 3 9
图4 手术时间森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 4 Forest plot of operation timeNote: CC-capsule-closure group; NC-non-capsule closure group
图5 并发症率森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 5 Forest plot of complication rateNote: CC-capsule-closure group; NC-non-capsule closure group
图6 HA(髋关节镜)翻修率森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 6 Forest plot of hip arthroscopy revision rateNote: CC-capsule-closure group; NC-non-capsule closure group
图7 翻修为THA(全髋关节置换)的概率森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 7 Forest plot of revision rate to total hip arthroplastyNote: CC-capsule-closure group; NC-non-capsule closure group
图8 MHHS分(改良Harris髋关节功能评)森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 8 Forest plot of modified Harris hip scoreNote: CC-capsule-closure group; NC-non-capsule closure group
图9 HOS-ADL(髋关节日常活动功能评分)森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 9 Forest plot of hip outcome score-activities of daily livingNote: CC-capsule-closure group; NC-non-capsule closure group
图10 HOS-SSS(髋关节体育运动功能评分)森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 10 Forest plot of hip outcome score-sports specific subscaleNote: CC-capsule-closure group; NC-non-capsule closure group
图11 MHHS分(改良Harris髋关节功能评)的MCID(最小临床重要性差值)达成率森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 11 Forest plot of minimal clinically important difference achievement rate of modified Harris hip scoreNote: CC-capsule-closure group; NC-non-capsule closure group
图12 运动能力恢复率森林图注：CC-闭合关节囊组；NC-不闭合关节囊组(对照组)
Figure 12 Forest plot of recovery rate of sports abilityNote: CC-capsule-closure group; NC-non-capsule closure group
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