McCarthy Joseph C, Lee Jo-Ann
New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA.
Clin Orthop Relat Res. 2004 Dec(429):157-62. doi: 10.1097/01.blo.0000150118.42360.1d.
Advancement in diagnostic and therapeutic applications for hip arthroscopy have dispelled previous myths about early hip disease. Arthroscopic findings have established the following facts: Acetabular labral tears do occur; acetabular chondral lesions do exist; tears are most frequently anterior and often associated with sudden twisting or pivoting motions; and labral tears often occur in association with articular cartilage lesions of the adjacent acetabulum or femoral head, and if present for years, contribute to the progression of delamination process of the chondral cartilage. Magnetic resonance arthrography represents an improvement over conventional magnetic resonance imaging, it does have limitations when compared with direct observation. Although indications for hip arthroscopy are constantly expanding, the most common indications include: labral tears, loose bodies, chondral flap lesions of the acetabular or femoral head, synovial chondromatosis, foreign body removal, and crystalline hip arthropathy (gout, pseudogout, and others). Contraindications include conditions that limit the potential for hip distraction such as joint ankylosis, dense heterotopic bone formation, considerable protrusio, or morbid obesity. Complication rates have been reported between 0.5 and 5%, most often related to distraction and include sciatic or femoral nerve palsy, avascular necrosis, and compartment syndrome. Transient peroneal or pudendal nerve effects and chondral scuffing have been associated with difficult or prolonged distraction. Meticulous consideration to patient positioning, distraction time and portal placement are essential. Judicious patient selection and diagnostic expertise are critical to successful outcomes. Candidates for hip arthroscopy should include only those patients with mechanical symptoms (catching, locking, or buckling) that have failed to respond to conservative therapy. The extent of articular cartilage involvement has the most direct relationship to surgical outcomes. Improvements in technique and instrumentation have made hip arthroscopy an efficacious way to diagnose and treat a variety of intra-articular problems.
髋关节镜检查在诊断和治疗应用方面的进展消除了先前关于早期髋关节疾病的误解。关节镜检查结果证实了以下事实：髋臼盂唇撕裂确实存在；髋臼软骨损伤确实存在；撕裂最常发生在前侧，且常与突然扭转或旋转动作相关；盂唇撕裂常与相邻髋臼或股骨头的关节软骨损伤同时出现，若存在多年，会促使软骨分层过程进展。磁共振关节造影相较于传统磁共振成像有所改进，但与直接观察相比仍有局限性。尽管髋关节镜检查的适应证在不断扩大，最常见的适应证包括：盂唇撕裂、游离体、髋臼或股骨头软骨瓣损伤、滑膜软骨瘤病、异物取出以及结晶性髋关节病（痛风、假性痛风等）。禁忌证包括限制髋关节牵引可能性的情况，如关节强直、致密性异位骨形成、明显髋臼前突或病态肥胖。据报道并发症发生率在0.5%至5%之间，最常见与牵引有关，包括坐骨神经或股神经麻痹、缺血性坏死和骨筋膜室综合征。短暂的腓总神经或阴部神经影响以及软骨擦伤与困难或长时间牵引有关。仔细考虑患者体位、牵引时间和入路位置至关重要。明智的患者选择和诊断专业知识对成功的治疗结果至关重要。髋关节镜检查的候选患者应仅包括那些对保守治疗无反应的机械性症状（卡顿、交锁或屈曲）患者。关节软骨受累程度与手术结果有最直接的关系。技术和器械的改进使髋关节镜检查成为诊断和治疗各种关节内问题的有效方法。
