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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Utility of Intra-articular Hip Injections for Femoroacetabular Impingement
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Utility of Intra-articular Hip Injections for Femoroacetabular Impingement

机译：髋关节内髋臼注射对髋臼髋臼撞击的实用性

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Background: Femoroacetabular impingement (FAI) is a condition that is becoming increasingly recognized as a common etiology of hip pain in athletes, adolescents, and adults. However, history and clinical examination are often inconclusive in reaching a diagnosis, while imaging often detects asymptomatic abnormalities. Treatment has traditionally been limited to surgery, with the role of conservative management remaining unclear. Purpose: To evaluate the utility of the intra-articular hip injection in the diagnosis and management of FAI. Study Design: Systematic review; Level of evidence, 4. Methods: MEDLINE, EMBASE, and PubMed databases were screened in duplicate for studies published between January 1946 and January 2014. Search terms included femoroacetabular impingement , hip impingement , and intra-articular injection . Quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) scale was completed for all included studies. Data evaluated included study design, study objectives, number of hips, injected product, duration of pain relief, and outcomes measured. Results: Our search yielded 8 studies involving 281 hips. Studies were categorized into diagnostic (4 studies), therapeutic (3 studies), and prognostic (1 study) applications. Patients with FAI and its degenerative sequelae obtained greater relief from diagnostic intra-articular hip injection than those without ( P < .05). The diagnostic intra-articular injection performed under ultrasound guidance was better tolerated than injections performed under fluoroscopic guidance (pain rating, 5.6 vs 3.0; P < .1). Intra-articular injection of hyaluronic acid was the most effective at providing pain relief (in 23 patients), with significant improvements of functional outcome measures (Harris Hip Score, visual analog scale) present at 12 months. Pooled results with corticosteroid injection resulted in improvement in only 15% (9/60) of patients at 6 weeks. A negative response to intra-articular hip injection was a strong predictor for poor surgical outcomes. Conclusion: The results of this review suggest that (1) pain relief obtained from an intra-articular hip injection supports a diagnosis of FAI, (2) therapeutic relief at 12 months may be achieved, particularly with hyaluronic acid, and (3) a negative response to preoperative injections may predict poor short-term surgical outcomes. Additional large studies are required to build on the small number of studies included in this review, and further delineate the role of intra-articular hip injection in the management of FAI.
机译：背景：髋臼前冲（FAI）是一种越来越被公认的运动员，青少年和成人髋关节疼痛的常见病因。但是，病史和临床检查通常不能确定诊断，而影像学检查通常可以发现无症状异常。传统上，治疗仅限于手术，保守治疗的作用尚不清楚。目的：评价髋关节内注射在FAI的诊断和管理中的实用性。研究设计：系统评价;证据等级，4。方法：一式两份地筛选MEDLINE，EMBASE和PubMed数据库，以研究1946年1月至2014年1月之间发表的研究。搜索词包括股骨髋臼撞击，髋部撞击和关节内注射。对于所有纳入的研究，均使用非随机研究方法学指数（MINORS）量表进行了质量评估。评估的数据包括研究设计，研究目标，臀部数量，注射产品，缓解疼痛的持续时间以及测量的结果。结果：我们的搜索产生了8个涉及281髋的研究。研究分为诊断（4个研究），治疗（3个研究）和预后（1个研究）应用。 FAI及其退行性后遗症的患者经诊断性髋关节内注射治疗比未接受FAI的患者获得了更大的缓解（P <.05）。在超声引导下进行的诊断性关节内注射比在荧光镜引导下进行的注射具有更好的耐受性（疼痛评分，5.6 vs 3.0; P <.1）。关节内注射透明质酸是最有效的止痛方法（23例），并且在12个月时功能预后指标（Harris Hip Score，视觉模拟量表）得到了显着改善。皮质类固醇注射液的汇总结果在6周时仅改善了15％（9/60）的患者。关节内髋关节注射阴性反应是手术效果差的有力预测指标。结论：本评价的结果表明：（1）髋关节内注射获得的疼痛缓解支持FAI的诊断;（2）尤其是透明质酸可达到12个月的治疗缓解;（3）a术前注射的阴性反应可能预示了短期的手术结果差。需要进行大量的大型研究，以本文中包含的少量研究为基础，并进一步描述关节内髋关节注射在FAI管理中的作用。

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