由外向内入路髋关节镜治疗髋臼盂唇损伤

Efficacy analysis of treatment of acetabular labrum injury by external to internal approach hip arthroscopy

摘要:

［目的］介绍由外向内入路髋关节镜治疗髋臼盂唇损伤的手术与治疗技术和初步临床结果。［方法］患者全麻后平卧于牵引架上，患肢屈髋10?，外展25?，内旋位，“C”臂机透视辅助下在髋部前、外侧方做体表标志，取常规的前方、前外侧及前外侧辅助入路。切开前方和前外侧入路皮肤约0.5cm，从前外侧入路插入钝头关节镜鞘套内芯，可感觉触及一坚韧组织，将鞘套内芯左右分离组织后拔出，将关节镜从前外侧入路置入，看见关节镜镜头位于髋关节囊前方。从前方入路插入等离子刀头，分离前方关节囊外组织，显露髋关节囊前方及前外侧。“Y”形切开髋关节囊前侧、外侧。将关节镜插入关节内，观察外侧间室。牵引患肢，显露并探查中央间室。探查盂唇损伤情况，并缝合修复盂唇［结果］选取2015年1月-2021年1月手术治疗的髋臼盂唇损伤患者30例作为研究对象，采用由外向内入路髋关节镜下修复盂唇手术。比较患者的术前、术后6个月、末次随访的VAS疼痛评分、改良Harris髋关节功能评分情况。所有患者均顺利完成手术，30例患者术后6个月、末次随访与术前相比，改良Harris髋关节评分和VAS评分均有显著改善(P＜0.001)；末次随访与术后6个月相比,改良Harris髋关节评分和VAS评分无显著性差异(P=0.103,0.49)。［结论］短期随访结果显示由外向内入路行髋关节镜治疗髋臼盂唇损伤可以取得满意的临床效果。

Abstract:

[Objective]To introduce the surgical and therapeutic techniques and preliminary clinical results of outside-in approach hip arthroscopy for the treatment of acetabular glenoid and labial injury. [Methods]After general anesthesia, the patient lay flat on the traction rack, the affected limb was bent at 10?, abducted at 25?, and in the internal rotation position. With the assistance of "C" arm fluoroscopy, body surface markers were made on the front and lateral sides of the hip, and conventional anterolateral, anterolateral and anterolateral auxiliary approaches were taken.The skin was cut about 0.5cm through the anterior and anterolateral approaches, and the inner core of the blunt arthroscope sheath was inserted through the anterolateral approach, pointing to the center of the femoral head with reference to the body surface signs.A tough tissue could be felt, the sheath inner core was separated from the left and right tissues and pulled out, and the arthroscope was placed in the anterolateral approach, and the arthroscopic lens was seen in front of the hip capsule. The plasma cutter head was inserted through the anterior approach to separate the anterior joint capsular tissue and reveal the anterior and anterolateral hip capsule."Y" incision was made on the anterior and lateral sides of the hip capsule. The arthroscope was inserted into the joint and the lateral compartment was observed. Pull the affected limb, expose and explore the central compartment. The lesion of the labrum was investigated and repaired by suture. [Results]Thirty patients with acetabular glenolabial injury who received surgical treatment from January 2015 to January 2021 were selected as the study objects, and hip arthroscopic repair of the glenolabial injury was performed by an external to internal approach. VAS pain score and modified Harris hip function score were compared before surgery, 6 months after surgery and at the last follow-up.All patients successfully completed the operation, 30 patients 6 months after surgery, the last follow-up, the modified Harris hip score and VAS score were significantly improved compared with the preoperative (P < 0.001); There was no significant difference between the modified Harris hip score and VAS score at the last follow-up compared with 6 months after surgery (P=0.103,0.49).. [Conclusion] The results of short-term follow-up showed that the treatment of acetabular labrum injury by external to internal approach hip arthroscopy can achieve satisfactory clinical results.