由周围室至中央室髋关节镜修复髋臼盂唇损伤

Arthroscopic repair of acetabular labral tear from the peripheral to central compartments

摘要:

[目的]介绍由周围室至中央室髋关节镜治疗髋臼盂唇损伤的手术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 形臂 X 线机透视辅助下在髋部前、外侧方做体表标志。自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]所有患者均顺利完成手术，术中均未出现严重并发症。随访 24~96 个月，与术前相比，末次随访时，患者疼痛 VAS 评分 [(6.7±1.2), (2.1±0.7), P＜0.001]、Harris 评分 [(52.8±6.4), (86.9±4.7), P＜0.001] 均显著改善，无患者需要翻修或者二次手术。[结论]由周围室至中央室髋关节镜治疗髋臼盂唇损伤的技术可行，缩短了术中牵引时间，初步临床效果满意。

关键词:髋臼盂唇损伤;髋关节镜;周围室;中央室;修复术

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic repair of acetabular labrum tear from the peripheral to central compartments. [Methods] The patient was placed in supine position on the fracture table after general an- esthesia, with the affected low limb in the internal rotation, hip flexion of 10° and abduction of 25°. The body surface markers were made on the front and lateral sides of the hip with the assistance of "C" arm fluoroscopy. A blunt trocar was inserted through the anterolateral portal, and as a tough tissue was felt, the trocar was moved from one side to other side to separate the tissues around the capsule, then inner trocar was pulled out and the arthroscope replaced. As the hip anterior capsule was exposed under arthroscope, “Y” shaped capsulotomy was done with a plasma cutter introduced from the anterior portal to reveal the anterolateral aspect of the hip joint, and the peripheral compart- ment was examined. Pulling the affected limb, the central compartment was exposed. Finally, the acetabular labrum injuries were evaluated and repaired with suture anchors. [Results] All patients were operated on smoothly without serious complications during the operation, and were followed up from 24 to 96 months. Compared with those preoperatively, the VAS score for pain [(6.7±1.2), (2.1±0.7), P＜0.001] and Harris score [(52.8±6.4), (86.9±4.7), P＜0.001] significantly improved at the latest follow-up. During the follow-up period, no revision or secondary surgery was performed in anyone of the patients. [Conclusion] This arthroscopic repair of acetabular labrum tear from the periph- eral to central compartments is feasible technique with shortened traction time, does achieve satisfactory preliminary clinical consequences.

Key words:acetabular labral tear; hip arthroscopy; peripheral compartment; central compartment; repair