Tibor Lisa M, Sink Ernest L
Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
J Pediatr Orthop. 2013 Jul-Aug;33 Suppl 1:S131-6. doi: 10.1097/BPO.0b013e318286006e.
A more detailed understanding of the anatomy of the medial femoral circumflex artery enabled the development of the modern technique for surgical hip dislocation. Although the surgical hip dislocation is best known as an open method for treating femoroacetabular impingement, it allows the surgeon to address a variety of different hip pathologies, including femoral head and posterior wall acetabular fractures, chondral defects requiring cartilage restoration techniques, and excision of benign tumors. When the technique of an extended retinacular flap is added, surgeons are able to perform intra-articular osteotomies and open reduction of slipped capital femoral epiphysis while preserving the blood supply to the femoral head. The surgical hip dislocation allows direct observation of both intra-articular and extra-articular impingement and a means of correcting both during 1 procedure. The downsides of the surgical hip dislocation are largely related to the trochanteric flip osteotomy, with up to half of patients reporting mild residual lateral hip pain 1 year postoperatively. Trochanteric nonunion and residual abductor weakness are also potential complications of the surgical hip dislocation technique. Several studies have shown improved pain and functional outcomes in short-term and mid-term follow-up after treatment of femoroacetabular impingement. It has a low complication rate in the hands of experienced surgeons and is an important technique for addressing complex intra-articular hip pathology that would be technically challenging arthroscopically.
对股内侧旋动脉解剖结构更深入的了解推动了现代髋关节手术脱位技术的发展。尽管髋关节手术脱位最为人所知的是作为一种治疗股骨髋臼撞击症的开放方法，但它使外科医生能够处理多种不同的髋关节病变，包括股骨头和髋臼后壁骨折、需要软骨修复技术的软骨缺损以及良性肿瘤切除。当增加延长的支持带瓣技术时，外科医生能够在保留股骨头血供的同时进行关节内截骨术和对股骨头骨骺滑脱进行切开复位。髋关节手术脱位可直接观察关节内和关节外撞击情况，并能在一次手术中对两者进行矫正。髋关节手术脱位的缺点主要与转子翻转截骨术有关，高达一半的患者术后1年报告有轻度的髋关节外侧残留疼痛。转子不愈合和外展肌残留无力也是髋关节手术脱位技术的潜在并发症。多项研究表明，在治疗股骨髋臼撞击症后的短期和中期随访中，疼痛和功能结果有所改善。在经验丰富的外科医生手中，其并发症发生率较低，并且是处理复杂的关节内髋关节病变的一项重要技术，而这些病变在关节镜下处理在技术上具有挑战性。
