[Predictive value of ultrasound-guided anesthesia injection in arthroscopy for borderline developmental dysplasia of the hip].

Objective: To evaluate the value of ultrasound-guided intra-articular anesthetic injection in predicting postoperative outcomes for borderline developmental hip dysplasia (BDDH). Methods: A follow-up study. The clinical data of 37 BDDH patients who received ultrasound-guided intra-articular anesthetic injection and arthroscopic examination in the Department of Sports Medicine, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital from May 2018 to February 2021 were retrospectively analyzed. Among them, there were 17 males and 20 females with a mean age of (37.9±12.8) years. All patients underwent ultrasound-guided intra-articular anesthetic injection prior to arthroscopy, and were evaluated with hip physical examination before and after injection, as well as before and after arthroscopy, in order to obtain the visual analog score (VAS) of pain for seven assessments. The total VAS score was calculated based on these evaluations. Follow-up was conducted for at least 12 months. The effective rate of injection referred to the ratio of the improvement of VAS score after anesthetic injection to the total VAS score before injection. Pearson correlation analysis and Bland-Altman analysis were used to test the correlation between modified Harris hip score (mHHS) after ultrasound-guided intra-articular anesthetic injection and mHHS score after arthroscopic surgery. A binary logistic regression model was established to analyze the substantial clinical benefit (SCB) for patients. Following the logistic regression analysis, a receiver operating characteristic (ROC) curve was constructed to evaluate the predictive power of ultrasound-guided intra-articular anesthetic injection in achieving SCB in those patients. The optimal cut-off value for injection efficacy was determined based on the ROC curve when SCB was achieved. Results: The follow-up time for all patients was (26.3±7.6) months. After anesthetic injection for 20 minutes, the total VAS score of pain [M(Q1,Q3)] decreased from 13(8,23) points before injection to 1(0,4) points; and the mHHS score [M(Q1,Q3)] increased from 60(46,70) points before arthroscopy to 90(84,96) points after, with statistically significant differences before and after injection and before and after arthroscopy (both P<0.001). Pearson correlation analysis showed that the mHHS score after intra-articular anesthetic injection was positively correlated with the mHHS score after surgery (r=0.961, P<0.001). The area under the ROC curve for predicting SCB after arthroscopy with ultrasound-guided intra-articular anesthetic injection was 0.769 (95%CI: 0.561-0.976), the Youden index was 0.663, the cut-off value was 0.569 2, the sensitivity was 96.3%, and the specificity was 70.0%. Conclusions: The results of ultrasound-guided intra-articular anesthetic injection before arthroscopy can indicate the presence of intra-articular lesions, and the degree of pain relief after injection is proportional to the functional recovery after arthroscopy. Patients with intra-articular anesthetic injection efficacy>56.92% have better results in hip arthroscopy.目的： 观察超声引导下关节腔麻醉注射预测临界性发育性髋关节发育不良（BDDH）术后疗效的应用价值。 方法： 随访研究。回顾性分析2018年5月至2021年2月在解放军总医院第四医学中心骨科医学部运动医学科接受超声引导下关节腔麻醉注射和关节镜检查的37例BDDH患者的临床资料，其中男17例，女20例，年龄（37.9±12.8）岁。所有患者在术前均接受超声引导下关节腔麻醉注射，注射前后及手术前后均接受髋关节体格检查，获得七项检查的疼痛视觉模拟评分（VAS）并计算VAS总评分，并进行至少12个月的随访。注射有效率指注射后VAS评分改善值与注射前VAS总评分的比值。使用Pearson相关性分析和Bland-Altman分析对超声引导下关节腔麻醉注射后改良Harris评分（mHHS）与术后mHHS评分进行相关性检验。建立二元logistic回归模型对患者实质性临床获益（SCB）进行分析，根据logistic回归模型输出结果构建超声引导下关节腔麻醉注射预测患者术后达到SCB的受试者工作特征（ROC）曲线并确定达到SCB时注射有效率的最佳cut-off值。 结果： 所有患者随访时间（26.3±7.6）个月。麻醉注射20 min后，患者的VAS总分［M（Q1，Q3）］由注射前的13（8，23）分降至1（0，4）分；mHHS评分［M（Q1，Q3）］由术前的60（46，70）分升至术后的90（84，96）分，前后差异均有统计学意义（均P<0.001）。Pearson相关分析显示，关节腔注射后mHHS评分与术后mHHS评分呈正相关（r=0.961，P<0.001）。超声引导下关节腔注射预测患者术后达到SCB的ROC曲线下面积为0.769（95%CI：0.561~0.976），约登指数为0.663，有效率的cut-off值为0.569 2，灵敏度为96.3%，特异度为70.0%。 结论： 术前超声引导下关节腔麻醉注射的结果可提示关节内病变的存在，麻醉注射后疼痛缓解程度与术后功能恢复呈正相关。超声引导下关节腔注射有效率>56.92%的患者髋关节镜手术结果更佳。.