Berend K R, Vail T P
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Clin Sports Med. 2001 Oct;20(4):763-78. doi: 10.1016/s0278-5919(05)70283-0.
The current literature offers only sparse reports of the use of hip arthroscopy in the pediatric patient injured during athletics. In contrast, the role of this technique in the diagnosis and treatment of multiple childhood hip conditions including pyarthrosis, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, coxa vara, juvenile chronic arthritis, chondrolysis, and avascular necrosis is well described. The application of this relatively uncommon technique to the young athlete has only recently become more attractive. The ability to examine and treat traumatic intra-articular pathology with minimal morbidity and prompt recovery is mandated by the young age of these patients and their demanding activity levels. Hip arthroscopists are now beginning to correlate preoperative physical exam findings and history with diagnosis and expectations for outcome. As our combined experience with this technique grows, the specific indications for its use in the young athlete become increasingly better defined. In pediatric and adolescent patients, the new onset of hip pain should warrant a high level of suspicion for the more common causes of pain such as infection, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, or developmental dysplasia. When these have been evaluated, further differential diagnosis should include labral tears, loose bodies, synovitis, and chondral lesions. As this review begins to elucidate, these conditions are amenable to arthroscopic evaluation and treatment. At this time, the presence of reproducible mechanical symptoms after a twisting or axial loading injury during athletics should prompt the orthopaedic surgeon to consider arthroscopic examination of the hip if conservative therapy fails. Satisfying and reproducible results have been achieved when using hip arthroscopy within these parameters.
目前的文献中仅有关于髋关节镜在运动中受伤的儿科患者中的应用的稀少报道。相比之下，该技术在诊断和治疗多种儿童髋关节疾病中的作用，包括脓性关节炎、Legg-Calvé-Perthes病、股骨头骨骺滑脱、髋内翻、幼年慢性关节炎、软骨溶解和缺血性坏死，已有详尽描述。将这种相对不常见的技术应用于年轻运动员，只是最近才变得更具吸引力。由于这些患者年龄小且活动需求高，要求以最低的发病率和快速恢复来检查和治疗创伤性关节内病变。髋关节镜医师现在开始将术前体格检查结果和病史与诊断及预后期望联系起来。随着我们对该技术的综合经验不断增加，其在年轻运动员中使用的具体适应证越来越明确。在儿科和青少年患者中，髋关节疼痛的新发应高度怀疑疼痛的常见原因，如感染、Legg-Calvé-Perthes病、股骨头骨骺滑脱或发育性髋关节发育不良。当对这些情况进行评估后，进一步的鉴别诊断应包括盂唇撕裂、游离体、滑膜炎和软骨损伤。正如本综述开始阐明的，这些情况适合进行关节镜评估和治疗。此时，如果保守治疗失败，在运动中发生扭转或轴向负荷损伤后出现可重复的机械性症状，应促使骨科医生考虑对髋关节进行关节镜检查。在这些参数范围内使用髋关节镜已取得了令人满意且可重复的结果。
