Background:

Hip dislocation is a rare occurrence during sports but carries serious implications for athletes.

Purpose:

To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets.

Results:

A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion (P = .015 and .068, respectively), increased prevalence of a cam deformity (P < .0035), higher alpha angles (P≤ .0213), and decreased posterior acetabular coverage (P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies).

Conclusion:

Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

中文翻译：

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运动员髋关节脱位和半脱位：系统评价

背景：

髋关节脱位在运动中很少发生，但对运动员有严重影响。

目的：

系统评价运动员髋关节脱位的治疗策略和结果，最终目标是为运动医学医生提供必要的信息，以适当地治疗和咨询遭受这种损伤的患者。

学习规划：

系统审查；证据水平，4。

方法：

PubMed、MEDLINE 和 Embase 搜索了 1989 年 1 月 1 日至 2019 年 10 月 1 日期间与髋关节不稳和田径运动相关的研究。根据预定义的纳入和排除标准对摘要和文章进行了评估。纳入标准如下：(1) 来自≥1 名患者的数据，(2) 运动期间发生的天然髋关节脱位或半脱位，(3) 年龄至少 10 岁的患者，以及 (4) 用英语书写。排除标准为 (1) 小于 10 岁的患者；(2) 非先天性或术后髋关节脱位或半脱位；(3) 没有脱位或半脱位的天然髋关节损伤；（4）继发于神经肌肉、发育或综合征的脱位或半脱位患者；（五）运动过程中未发生脱位、半脱位；(6) 骺板骨折患者；(7) 评论文章或荟萃分析。记录了患者人口统计学、损伤机制、治疗策略以及临床和影像学结果的数据。在可能的情况下，进行了汇总分析。根据报告的结果对研究进行分组。然后对这些汇集的子集进行荟萃分析。

结果：

初步确定共602篇文章，经2位审稿人筛选，27篇报道145名患者的文章被纳入最终评价。有 2 项研究确定了后脱位患者和对照组之间的形态学差异，包括髋臼前倾减少（分别为P = .015 和 0.068）、凸轮畸形患病率增加（P < .0035）、α 角增加（P ≤ .0213），髋臼后部覆盖率降低（P< .001)。横向中心边缘角或托尼斯角没有发现差异。保护性减重后负重最常规定为 2 至 6 周，65% 的报告作者推荐触地、脚趾触地或拐杖辅助负重。3%的病例报告有复发。总体而言，4 项研究报告了髋关节镜手术的发现，包括 100% 的盂唇撕裂发生率（n = 27；4 项研究）、92% 的软骨损伤发生率、20% 的关节囊撕裂发生率和 84% 的圆韧带发生率眼泪（n = 25；2 项研究）。在最终随访中，86% 的患者报告没有疼痛（n = 14；12 项研究），87% 的患者报告成功重返赛场（n = 39；10 项研究），11% 的患者有骨坏死的影像学证据（n = 38；10 项研究）。

结论：

文献中描述了各种治疗策略，多种方法在体育活动期间持续存在的天然髋关节脱位患者中产生了有希望的临床和影像学结果。数据支持对向心复位且无明显骨折的髋关节进行保护性负重的非手术治疗，如果仅通过闭合方式无法实现，则通过手术干预获得向心复位。建议对骨坏死进行影像学检查，有证据表明对股骨头有可疑发现的患者进行 4 至 6 周的磁共振成像和 3 个月的随访。