Wettstein Michael, Jung Jochen, Dienst Michael
Department of Orthopaedic Surgery, University Hospital, Homburg/Saar, Germany.
Arthroscopy. 2006 Aug;22(8):907.e1-4. doi: 10.1016/j.arthro.2005.12.064.
Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months.
如果保守治疗无效，对于腰大肌肌腱炎或疼痛性弹响，可考虑进行肌腱切断术。由于开放技术存在严重并发症，因此开发了内镜手术。我们提出一种新的关节镜技术，用于从髋关节进入并松解腰大肌肌腱。该手术可在髋关节的其他关节镜手术的基础上进行，也可单独进行。为排除其他髋关节疾病，应先完成一轮关节诊断检查。在完成髋关节中央间室的关节镜检查后，松开牵引，将30度关节镜通过位于股骨颈前方的近端前外侧入口置入。可识别内侧滑膜皱襞。该皱襞位于腰大肌肌腱水平的前内侧关节囊下方稍内侧。将关节镜转向前方关节囊。有时，肌腱可透过薄的关节囊显现出来，甚至可通过股骨头颈交界处水平连接髋关节和髂耻滑囊的孔直接进入。如果无法做到这一点，则通过前方入口插入电热探头，做一个2厘米的横向关节囊切口。使用电热装置的背面朝向腰大肌肌腱前方的髂肌来松解肌腱。当可见肌腱残端有一定距离的间隙且髂肌纤维可见时，即实现完全松解。按照该技术进行手术的前9例患者均未出现并发症，且其髋关节屈曲力量在3个月内恢复正常。
