Poh S-Y, Hube R, Dienst M
Orthopädische Chirurgie München (OCM), Steinerstraße 6, 81369, Munich, Germany.
Oper Orthop Traumatol. 2015 Dec;27(6):536-52. doi: 10.1007/s00064-015-0400-1. Epub 2015 Sep 4.
Arthroscopic resection of the bony overhang of the acetabular rim with concurrent treatment of associated chondrolabral injury in order to improve femoroacetabular clearance, provide symptomatic relief and in theory, delay the onset or progression of osteoarthritis of the hip.
Clinical and radiographic evidence of femoroacetabular pincer or combined impingement, with minimal to moderate degenerative change in the hip joint.
Advanced osteoarthritis of the hip joint. Femoroacetabular pincer impingement arising from generalised overcoverage, e.g. coxa profunda. Acetabular retroversion in a dysplastic hip.
Arthroscopy of the peripheral compartment, using a proximal anterolateral viewing portal and anterior and anterolateral working portals. Labral assessment, release from its capsular reflection, limited bony resection of the acetabular rim or labral ossification. Central compartment arthroscopy under traction, using the anterolateral and anterior portals alternately as viewing and working portals, and a distal anterolateral accessory portal. The labrum is detached to expose the bony overhang in the acetabular rim, which is resected with a burr. The labrum is refixed if it is of sufficient quality and debrided or resected otherwise.
Labral resection: partial weight bearing, with pain-controlled progression to full weight bearing over 1-2 weeks. Labral refixation: Protected (20 kg) weight bearing for the first 4 weeks. Continuous passive motion therapy and the use of a stationary bicycle for 4 weeks, and early proprioceptive training are part of the rehabilitation regimen.
Arthroscopic treatment of femoroacetabular impingement has been shown to provide symptomatic relief, improve hip outcome scores and is postulated to delay progression of osteoarthritis. Better clinical outcomes can be obtained with labral refixation if the labrum is of sufficient quality.
关节镜下切除髋臼缘骨赘并同时治疗相关的软骨盂唇损伤，以改善股骨髋臼间隙，缓解症状，并从理论上延缓髋关节骨关节炎的发生或进展。
股骨髋臼钳夹或复合型撞击的临床及影像学证据，髋关节存在轻度至中度退变改变。
髋关节晚期骨关节炎。由广泛性髋臼覆盖过度引起的股骨髋臼钳夹撞击，如髋臼过深。发育不良髋关节中的髋臼后倾。
经外周间隙关节镜检查，采用近端前外侧观察入口及前侧和前外侧工作入口。评估盂唇，从其关节囊附着处松解，对髋臼缘或盂唇骨化进行有限的骨切除。在牵引下进行中央间隙关节镜检查，交替使用前外侧和前侧入口作为观察和工作入口，并使用远端前外侧辅助入口。将盂唇分离以暴露髋臼缘的骨赘，用磨钻将其切除。如果盂唇质量足够，则将其重新固定，否则进行清创或切除。
盂唇切除：部分负重，根据疼痛情况在1 - 2周内逐渐进展至完全负重。盂唇重新固定：最初4周进行保护性（20千克）负重。持续被动运动治疗及使用固定自行车4周，早期本体感觉训练是康复方案的一部分。
关节镜治疗股骨髋臼撞击已被证明可缓解症状，改善髋关节预后评分，并推测可延缓骨关节炎进展。如果盂唇质量足够，盂唇重新固定可获得更好的临床效果。
