当前位置: X-MOL 学术Am. J. Sports Med. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Autograft Versus Allograft: The Evidence in Hip Labral Reconstruction and Augmentation
The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2021-10-19 , DOI: 10.1177/03635465211042633
Joseph D Cooper 1 , Travis J Dekker 1 , Joseph J Ruzbarsky 1 , Lauren A Pierpoint 1 , Rui W Soares 1 , Marc J Philippon 1
Affiliation  

Background:

Labral augmentation and labral reconstruction have emerged as essential procedures for restoring the anatomic and functional characteristics of the hip joint in patients with a deficient hip labrum or irreparable labral tear.

Hypothesis/Purpose:

The purpose of this study was to compare allograft and autograft hip labral reconstruction and augmentation. We hypothesized that autografts would entail fewer revision arthroscopic procedures.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients were identified who underwent labral reconstruction or labral augmentation using iliotibial band (ITB) allograft or ITB autograft performed by a single surgeon between 2011 and 2017. Patient-reported outcome measures collected before surgery and at minimum 2-year follow-up included the following: Hip Outcome Score Activities of Daily Living and Hip Outcome Score Sports-Specific Subscale and, at follow-up, patient satisfaction (range, 1-10, with 10 being very satisfied). Patients followed a standardized rehabilitation protocol after surgery with relative individualization to address each patient's needs. For continuous variables, comparisons between allografts and autografts were made using Student t tests or Mann-Whitney tests. Categorical comparisons were assessed using chi-square or Fisher exact test. Multiple logistic regression was performed to determine the influence of graft choice on risk of revision or THA.

Results:

A total of 205 hips met 2-year inclusion criteria. ITB allografts were used for 55 patients (37 augmentations, 18 reconstructions) and ITB autografts for 150 patients (34 augmentations, 116 reconstructions). Females represented a greater proportion of allograft versus autograft patients (71% vs 46%, respectively; P = .001). Overall, autograft patients had larger alpha angles (66.6° vs 59.1°; P = .001) and longer grafts (46 vs 41 mm; P = .03) compared with allograft patients. A total of 13 (23.6%) patients required revision surgery in the allograft group compared with 11 (7.3%) in the autograft group (P < .001). After controlling for sex, procedure (reconstruction vs augmentation), and previous surgery, the odds of revision were higher for allograft patients (OR, 4.1; 95% CI, 1.5-11.6). No significant differences in conversion to THA were observed between groups (allograft = 9%; autograft = 6%; P = .50), even after adjustment for the above covariates (OR, 2.3; 95% CI, 0.6-7.9). No differences in postoperative patient-reported outcome measures or patient satisfaction were observed between groups.

Conclusion:

Labral augmentation or reconstruction with autograft has a significantly lower revision rate than labral augmentation or reconstruction with allograft.



中文翻译:

自体移植与同种异体移植:髋关节盂唇重建和增大的证据

背景:

盂唇增大和盂唇重建已成为修复髋关节盂唇缺陷或无法修复的盂唇撕裂患者髋关节解剖和功能特征的必要程序。

假设/目的:

本研究的目的是比较同种异体移植物和自体移植物髋关节盂唇重建和增强。我们假设自体移植需要较少的翻修关节镜手术。

学习规划:

队列研究;证据等级,3。

方法:

确定了在 2011 年至 2017 年间由一位外科医生使用髂胫束 (ITB) 同种异体移植物或 ITB 自体移植物进行盂唇重建或盂唇增大术的患者。 术前收集的患者报告结果测量和至少 2 年的随访包括以下内容:日常生活的髋关节结果评分活动和髋关节结果评分运动特定分量表,以及随访时的患者满意度(范围为 1-10,10 分表示非常满意)。患者在手术后遵循标准化的康复方案,并进行相对个性化的治疗,以满足每位患者的需求。对于连续变量,同种异体移植物和自体移植物之间的比较使用 Student t测试或曼惠特尼测试。使用卡方或Fisher精确检验评估分类比较。进行多元逻辑回归以确定移植物选择对翻修或 THA 风险的影响。

结果:

共有 205 髋符合 2 年纳入标准。55 名患者使用 ITB 同种异体移植物(37 次增强,18 次重建),150 名患者使用 ITB 自体移植物(34 次增强,116 次重建)。与自体移植患者相比,女性代表了更大比例的同种异体移植患者(分别为 71% 和 46%;P = .001)。总体而言,与同种异体移植患者相比,自体移植患者具有更大的 α 角(66.6° 对 59.1°;P = .001)和更长的移植物(46 对 41 毫米;P = .03)。同种异体移植组共有 13 名(23.6%)患者需要翻修,而自体移植组有 11 名(7.3%)患者(P< .001)。在控制性别、手术(重建与增强)和既往手术后,同种异体移植患者的翻修几率更高(OR,4.1;95% CI,1.5-11.6)。即使在调整上述协变量(OR,2.3;95% CI,0.6-7.9)后,组间也未观察到 THA 转化率的显着差异(同种异体移植物 = 9%;自体移植物 = 6%;P = .50)。两组之间没有观察到术后患者报告的结果测量或患者满意度的差异。

结论:

自体移植的盂唇增大或重建的翻修率明显低于同种异体移植的盂唇增大或重建。

更新日期:2021-10-20
down
wechat
bug