Lodhia Parth, McConkey Mark O, Leith Jordan M, Maldonado David R, Brick Matthew J, Domb Benjamin G
Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
Fraser Orthopaedic Institute, 403-233 Nelson's Crescent, New Westminster, BC, V3L 0E4, Canada.
Curr Rev Musculoskelet Med. 2021 Feb;14(1):16-26. doi: 10.1007/s12178-020-09690-4.
The last decade has seen a boom in hip arthroscopy with refined indications. Improved understanding of pathoanatomy and disease progression has allowed for the development of advanced techniques. Labral reconstruction has been developed to substitute a non-functional or absent labrum. It has become an important technique in the armamentarium of high-volume arthroscopic hip surgeons.
Basic science studies have improved understanding of hip biomechanics in the presence and absence of a labrum with a labral reconstruction allowing for reconstitution of normalcy. Current techniques have shown success with autograft and allograft tissue options. While autograft tissue allows for easy access intra-operatively and maintains patient biology, donor site morbidity is possible. Allografts negate donor site morbidity and allow for an abundance of tissue but can be resource-intensive and face availability concerns. Recent studies support outcomes of labral reconstructions using both autograft and allograft. Promising results have also allowed for performing labral reconstruction in a primary setting. Labral reconstruction can be successfully performed using both autograft and allograft. Patient biology should be respected, and native hip biomechanics restored. The literature is plentiful for appropriate surgical decision-making allowing the surgeon with multiple graft choices depending on training, experience, and resources.
在过去十年中,髋关节镜检查因适应证的细化而蓬勃发展。对病理解剖和疾病进展的深入理解推动了先进技术的发展。盂唇重建技术已被开发出来,用于替代功能不良或缺失的盂唇。它已成为大量进行关节镜髋关节手术的外科医生的重要技术手段。
基础科学研究增进了对存在和不存在盂唇时髋关节生物力学的理解,盂唇重建可实现恢复正常状态。目前的技术在自体移植物和同种异体移植物组织选择方面都取得了成功。虽然自体移植物组织在手术中易于获取并保留了患者自身的生物学特性,但可能存在供区并发症。同种异体移植物可避免供区并发症,且有丰富的组织来源,但可能资源消耗大且存在可用性问题。近期研究支持使用自体移植物和同种异体移植物进行盂唇重建的效果。取得的良好结果也使得在初次手术时即可进行盂唇重建。使用自体移植物和同种异体移植物均可成功进行盂唇重建。应尊重患者的生物学特性,并恢复髋关节的自然生物力学。有大量文献可供参考,有助于做出恰当的手术决策,使外科医生能够根据培训、经验和资源情况做出多种移植物选择。