Orthopaedic Surgery Service, William Beaumont Army Medical Center, 5005 N Piedras Street, El Paso, TX 79920, USA.
Clin Orthop Relat Res. 2010 Nov;468(11):3121-5. doi: 10.1007/s11999-010-1256-1. Epub 2010 Feb 10.
Hip arthroscopy is a common orthopaedic procedure used as a diagnostic and therapeutic tool with a multitude of surgical indications. The complication rate is reportedly between 1.3% and 23.3%. Major complications are related to traction, fluid extravasation, and iatrogenic chondral injury. Although osteonecrosis is a concern with any surgical procedure about the hip, this complication has been primarily a theoretical concern with hip arthroscopy.
We report the case of a 24-year-old man who presented with a 2-year history of left hip pain. He underwent hip arthroscopy to include débridement of a torn labrum and removal of a prominent pincer lesion for femoroacetabular impingement. Traction was initiated by applying manual traction to the traction bar until 10 mm of joint distraction was obtained. Traction was removed at 90 minutes. At the 3-month followup, MRI showed osteonecrosis in the subcapital region of the left femoral head.
It generally is agreed the magnitude and duration of traction during hip arthroscopy increase the risk of traction-related injuries. Only one previous case of femoral head osteonecrosis associated with hip arthroscopy has been reported, and this may have resulted from the initial traumatic event. Based on anatomic studies, the use of standard arthroscopic portals would not put at risk any dominant normal vascular structures supplying the femoral head. In contrast, the literature shows that femoral head osteonecrosis may develop secondary to a combination of increased intraarticular pressure and traction.
We suspect this case of femoral head osteonecrosis after hip arthroscopy was caused by traction used in the procedure.
髋关节镜检查是一种常见的骨科手术，可作为诊断和治疗工具，具有多种手术适应证。据报道，其并发症发生率在 1.3%至 23.3%之间。主要并发症与牵引、液体外渗和医源性软骨损伤有关。尽管股骨头坏死是任何与髋关节相关的手术都需要关注的问题，但这种并发症在髋关节镜检查中主要是理论上的担忧。
我们报告了一例 24 岁男性患者，其左髋关节疼痛病史 2 年。他接受了髋关节镜检查，包括撕裂的半月板清创术和切除突出的撞击钳病变以治疗股骨髋臼撞击症。通过向牵引杆施加手动牵引，直到获得 10mm 的关节分离，开始进行牵引。在 90 分钟时移除牵引。在 3 个月的随访中，MRI 显示左侧股骨头的近侧区域发生骨坏死。
一般认为髋关节镜检查过程中的牵引幅度和时间会增加与牵引相关的损伤风险。仅报道过一例与髋关节镜检查相关的股骨头坏死病例，这可能是由于初始创伤事件引起的。根据解剖学研究，使用标准关节镜入路不会使供应股骨头的任何主要正常血管结构面临风险。相比之下，文献表明股骨头坏死可能是由于关节内压力和牵引增加的组合而发生的。
我们怀疑该例髋关节镜检查后发生股骨头坏死是由于该手术中使用的牵引所致。
