髋关节镜技术

作为微创与直视相结合的一种治疗手段,髋关节镜技术在电子光学、计算机和影像学的带动下,已成为诊断和治疗髋关节内疾患的有效方法。髋关节镜的适应证逐渐扩大,目前几乎可对所有髋关节内疾患进行诊断和治疗。髋关节镜在组织活检、腔内冲洗、骨赘清除、滑膜切除、微骨折技术诊治髋臼撞击综合征、软骨损伤、盂唇损伤、人工髋关节置换术后疼痛、不明原因髋痛,以及既往需开放手术的儿童先天性髋部疾患、股骨头坏死、髋部退行性变等方面,均表现出极大的优势。该文就髋关节镜的适应证、操作方法、康复、评价标准及诊治常见髋部疾患的效果等作一简要综述。     

髋关节镜外科的研究进展

近20年来,髋关节镜技术作为微创与直视相结合的一种治疗手段,在电子光学、计算机和影像学的带动下,成为诊断和治疗髋关节内疾患的最有效方法之一,其适应证逐渐扩大,甚至逐渐成为诊断髋关节疾病的金标准.本文就髋关节镜的适应证、并发症、操作方法、最新诊治及术后康复进展作一综述.研究表明,髋关节镜对于既往不明原因的髋痛如髋关节撞击征、髋臼盂唇、髋臼软骨损伤可以早期诊断和治疗.此外,髋关节镜在股骨头坏死、股骨头圆韧带损伤、髋关节置换后的应用也展现出极大的应用前景.ゥ     

髋关节镜技术

早在 1931年Ｂｕｒｍａｎ就试图施行髋关节镜检查术 ,但限于当时的技术条件和对髋关节生理的认识 ,手术未取得实质进展。Ｂｕｒｍａｎ甚至得出“不可能将一细针置入股骨头与髋臼之间”的结论[1] 。真正的髋关节镜诊疗技术开始于 70年代后期 ,2 0年来无论是基础理论还是临床实践都取得了长足进步。当前 ,这一微侵袭内窥技术已在髋关节疾患的诊疗中起到越来越重要的作用。一、外科技术及应用解剖1.麻醉、体位及入路 :髋关节是一深在的杵臼关节 ,周围有强大的关节囊、韧带、肌肉附着 ,且髋臼对股骨头的包容较好。因此 ,髋关节镜诊疗术需在牵引…     

髋关节镜治疗髋关节撞击综合征

<正>2016年9月～2017年4月,我科采用髋关节镜治疗12例髋关节撞击综合征患者,临床疗效满意,报道如下。1材料与方法1. 1病例资料本组12例,男9例,女3例,年龄25～56岁。凸轮型3例,钳夹撞击型2例,凸轮钳夹撞击型7例。病程6～32个月。1. 2治疗方法硬膜外麻醉或全身麻醉下手术。患者仰卧于骨科牵引床(牵引床会阴柱包裹后的直径不小于12cm),患侧髋关节伸直位、外展10°中立位。轻度屈髋可放松关节囊并利于牵引。牵引程度:髋关节腔内出现真空影     

髋关节镜的治疗进展

髋关节是人体重要的负重关节,周围有坚强的肌肉保护以及丰富的神经结构,这使得对其病变的诊断及治疗相对困难。常规手术往往会严重损害周围软组织及重要结构,术后出现关节粘连等并发症的可能性较大。随着关节镜器械及技术的发展,髋关节镜的应用近20年得到了迅速发展,其具有切口小,对周围组织神经损伤轻等优点。关节镜对髋关节病变的诊断起到了重要作用,同时还提供了更好的治疗方式。随着设备与技术的改进,MRI在髋关节疾病诊断的广泛应用,关节镜微创治疗逐渐成为髋关节疾病的临床技术之一。     

髋关节镜外科进展

髋关节是一个深在的杵臼关节，由于早期对它的病理及解剖知识的缺乏，使得髋关节镜的发展落后于其它关节镜的应用。1931年Burman第1次介绍了髋关节镜。后经历了漫长的时期，直到最近20年来，随着髋关节镜设备及技术的发展，人们对关节病变认识的加深，关节镜的应用才迅速发展起来，适应证也在不断的扩大。本文就髋关节镜在关节损伤、股髋撞击症、髋关节发育不良、骨关节炎等病变的诊治进展作一综述。     

髋关节镜术治疗髋关节病变初步观察

目的探讨髋关节镜术在治疗髋关节疾病中的应用价值. 方法在C臂X光机透视下对16例髋关节病变患者进行关节镜检查及治疗,根据术前及术后Harris髋关节评分判断手术疗效. 结果 Harris髋关节评分术前(49.0±6.3)分, 术后(84.0±3.6)分,手术前、后Harris评分有显著性差异(t=4.81,P<0.001).术中及术后无并发症发生,平均住院12.6天,随访6月～22月. 结论髋关节镜手术具有损伤小、恢复快的优点,对减轻髋关节疼痛、改善关节功能有明显的近期疗效,其远期疗效有待进一步观察.     

髋关节镜手术治疗股骨头缺血性坏死

目的 探讨应用髋关节镜手术治疗股骨头缺血坏死的疗效。方法 对３３例Ⅱ期或Ⅲ期的股头缺血坏死患者，进行了关节镜下髓心减压入路；游离骨膜及骨柴植入或经关节囊带血管蒂髂骨瓣转移的方法治疗，平均随访１年９个月。结果 所有病人疼痛消失，行走正常，髓关节活动范围正常或接近正常，Ｘ线片示股骨头轮廓清晰，囊性变消失，骨密度均匀，关节间隙正常。结论 关节镜下手术治疗股骨头缺血性坏死具有损伤小、准确、有效、简便的优点     

Hip arthroscopy

With adequate patient screening and attention to complications specific to the hip joint, hip arthroscopy can be performed safely and effectively. When used in appropriately selected patients, the reduced recovery and rehabilitation time is significant. In the past decade, the indications for hip arthroscopy have evolved to include a variety of pathologies, which has lead to a dramatic rise in its use.     

Hip arthroscopy: evolving frontiers

The basic principles of hip arthroscopy have been well developed and well accepted. Arthroscopy has been instrumental in understanding numerous aspects of hip joint disorders. Operative arthroscopy has met with successful results for a variety of conditions. The outcomes continue to improve and the indications continue to evolve. Arthroscopy has expanded from the intra-articular compartment to the peripheral aspect of the joint, allowing greater access to various lesions. Extracapsular and endoscopic techniques can now be employed in the hip region. These methods are beginning to evolve from resection to restorative procedures. Also, with a better understanding of the pathomechanics and natural disease process, arthroscopy may have a preventative role in the development of subsequent pathology. The basic technique and emerging technology are illustrated in this chapter.     

Hip arthroscopy in the pediatric population

Hip arthroscopy has obvious advantages over arthrotomy in the pediatric population. Hip arthroscopy, used as a diagnostic or therapeutic tool, is significantly less invasive than arthrotomy and allows for quicker recovery and return to activities. In addition, arthroscopy avoids dislocation of the femoral head and the corresponding risk of osteonecrosis. Current indications for hip arthroscopy in pediatric patients include septic arthritis, labral disorders, slipped capital femoral epiphysis, and Legg-Calvé-Perthes disease. The role of hip arthroscopy in the pediatric population will continue to expand because of its attractiveness as a less invasive option for evaluating the hip.     

Hip arthroscopy in Legg-Calve-Perthes disease.

The case of a 7-year-old boy with Legg-Calve-Perthes disease is presented. He had a prominent island of superficial epiphyseal ossification in his right femoral head, an unusual finding in Legg-Calve-Perthes disease. Hip arthroscopy was used successfully to identify and treat the lesion. After the procedure, the patient had a reduction in pain and an increase in range of hip motion. We believe that this case demonstrates the effective use of hip arthroscopy in the treatment of this unusual sequela of Legg-Calve-Perthes disease.     

Hip arthroscopy in children and adolescents

Hip arthroscopy has become an established procedure for certain indications in adults, but experience in children and adolescents has been more limited. The purpose of this study is to report the early-term results of hip arthroscopy in children and adolescents. A consecutive case series of 54 hip arthroscopies in 42 patients 18 years old and younger over a 3-year period at a tertiary-care children's hospital with a minimum of 1 year of follow-up was reviewed. Patients were assessed with the modified Harris hip score (HHS) before and after surgery. Overall results and results by common diagnoses were analyzed. Indications for surgery included isolated labral tear (n = 30), Perthes disease (n = 8), hip dysplasia with labral tear after prior periacetabular osteotomy (n = 8), inflammatory arthritis (n = 3), spondyloepiphyseal dysplasia (n = 2), avascular necrosis (n = 1), slipped capital femoral epiphysis (n = 1), and osteochondral fracture (n = 1). Overall, there was a significant improvement in HHS from 53.1 to 82.9 (P < 0.001), with 83% of patients improved. By diagnosis, significant improvement in HHS was seen for patients with isolated labral tears undergoing labral debridement (before surgery 57.6; after surgery 89.2; P < 0.001), for patients with Perthes disease undergoing chondroplasty and loose body excision (before surgery 49.5; after surgery 80.1; P < 0.001), and for patients with hip dysplasia after prior periacetabular osteotomy undergoing labral debridement (before surgery 51.8; after surgery 79.8; P < 0.001). Complications included transient pudendal nerve palsy (n = 3), instrument breakage (n = 1), and recurrent labral tear (n = 3). Hip arthroscopy in children and adolescents appears to be safe and efficacious for certain indications in the short term.