Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A..
Arthroscopy. 2020 Jan;36(1):116-123. doi: 10.1016/j.arthro.2019.06.040. Epub 2019 Nov 7.
To quantify the damage to the soft tissue stabilizers of the hip after a transverse interportal capsulotomy and subspine trimming in hip arthroscopy.
Eight human cadaveric hemipelvises underwent hip arthroscopy through a transverse interportal capsulotomy. Arthroscopic subspine trimming performed on all specimens was classified according to an anatomic index. The width of the proximal capsule was measured before and after subspine trimming. The extent of damage to the iliofemoral ligament (IFL) after dissection was recorded. Potential damage to pericapsular structures was assessed by measuring the distance between the capsulotomy and rectus femoris and iliocapsularis muscle with an electronic caliper.
In all specimens, ≥50% of the width of the IFL was damaged. The subspine trimming was successfully performed in 7 of 8 specimens (87.5%) according to the proposed index. The sizes of the trimmed bone area measured in the anteroposterior and proximal-distal axis were 21.2 ± 7.5 and 13.1 ± 9 mm, respectively (mean ± standard deviation). The width of the proximal capsule at the anterior and posterior corner of the capsulotomy was 19.8 ± 5.2 and 11.8 ± 1.7 mm, respectively. After subspine trimming, the mean width of the anterior and posterior proximal capsular attachments was 6.4 ± 1.4 and 7.0 ± 1.6 mm, respectively. On average, 13.4 mm of anterior capsule was damaged after anterior inferior iliac spine trimming, versus 4.7 mm of the posterior capsule. The distances from the capsulotomy to the rectus femoris direct and reflected head were 6.8 ± 4.9 and 6.3 ± 7.7 mm, respectively, and to the iliocapsularis muscle, 11.5 ± 7.8 mm.
High rates of damage to the IFL were observed with the interportal capsulotomy. Increased tissue damage at the anterior capsule was observed after subspine trimming. The width of the proximal capsular attachment was ≥5 mm in all specimens.
Surgeons should be aware of the potential damage to the native capsule and pericapsular structures when using a transverse interportal capsulotomy for the arthroscopic subspine decompression.
IV: cadaveric study, case series.
量化髋关节镜下横切口囊切开术和脊柱下修整术后对髋关节软组织稳定器的损伤。
8 个人体半骨盆标本行髋关节镜下横切口囊切开术。所有标本均根据解剖学指标行关节镜下脊柱下修整术。测量脊柱下修整术前和术后近端囊的宽度。记录在解剖过程中对髂股韧带（IFL）的损伤程度。用电子卡尺测量囊切开术与股直肌和髂囊肌之间的距离，评估关节囊周围结构的潜在损伤。
在所有标本中，IFL 的宽度有≥50%被损伤。根据提出的指标，8 个标本中有 7 个（87.5%）成功地完成了脊柱下修整术。在前后轴和近远轴上测量的修整骨面积分别为 21.2 ± 7.5 和 13.1 ± 9 mm（平均值 ± 标准差）。囊切开术前后角的近端囊宽度分别为 19.8 ± 5.2 和 11.8 ± 1.7 mm。脊柱下修整术后，前、后近端囊附着的平均宽度分别为 6.4 ± 1.4 和 7.0 ± 1.6 mm。平均而言，在前髂下棘修整后，前囊有 13.4mm 受损，而后囊有 4.7mm 受损。囊切开术与股直肌直接头和反射头的距离分别为 6.8 ± 4.9 和 6.3 ± 7.7 mm，与髂囊肌的距离为 11.5 ± 7.8 mm。
横切口囊切开术观察到 IFI 高损伤率。脊柱下修整术后前囊的组织损伤增加。所有标本的近端囊附着宽度均≥5mm。
当使用横切口囊切开术进行关节镜下脊柱下减压时，外科医生应注意对固有囊和关节囊周围结构的潜在损伤。
IV：尸体研究，病例系列。
