Rühmann Oliver, Puljić Patrik, Schierbaum Bernhard, Wünsch Markus, Lerch Solveig
Klinik für Orthopädie, Unfallchirurgie, Sportmedizin, Klinikum Agnes Karll Laatzen/Klinikum Region Hannover, Hildesheimer Str. 158, 30880, Laatzen, Deutschland.
Oper Orthop Traumatol. 2021 Feb;33(1):55-76. doi: 10.1007/s00064-020-00697-1. Epub 2021 Feb 3.
Arthroscopy of the central and peripheral compartment is an obligatory part of hip arthroscopy to evaluate, confirm or find pathologies and their treatment.
Loose bodies, lesions of the labrum and ligamentum capitis femoris, cartilage damage, femoroacetabular impingement, synovial diseases, initial osteoarthritis, femoral head necrosis (ARCO stage 1-2) and adhesions.
Local infections, bone tumors near the joint, extensive peri-articular ossification, severe arthrofibrosis with peri-articular involvement, advanced osteoarthritis, protrusio acetabuli, advanced femoral head necrosis (from ARCO stage 3-4 extended), recent fracture of the acetabulum and extensive joint capsule tears.
Precise positioning of the patient on a fracture table is essential to avoid complications. Central and peripheral compartment arthroscopy requires at least 2, in some cases more than 3 portals. Arthroscopy of the central compartment is carried out under traction by an anterolateral (AL) and anterior portal (A). A posterolateral (PL) portal and distal ventrolateral portal (DVL) may also be required. For peripheral compartment arthroscopy, an anterolateral (AL) and anterior (A), alternatively/additively a proximal ventrolateral portal (PVL) and/or and distal ventrolateral (DVL) portal are established in 45° flexion and no traction of the hip joint.
Mobilization with full weight bearing from the day of the operation, crutches are optional. After stimulating cartilage surgery or autologous chondrocyte transplantation, partial weight bearing of 10 kg on crutches is indicated until the end of postoperative week 6. Physiotherapy with full range of motion allowed, except for labrum refixation, should take place from postoperative day 1.
From 01/2010-12/2019, 2815 hip arthroscopies were performed; average patient age 43 (12-81) years. All procedures include a diagnostic arthroscopy of the hip. Two to 5 portals were used. Average operation time was 70 (18-48) min. In 26 cases (0.9%), arthroscopy of the central compartment at a high CE angle was not possible or not performed, even after previous arthroscopy of the peripheral compartment with capsule release. Intraoperative or directly postoperative problems and complications were rare, e.g., damage to the skin/genitals due to contact pressure (0.7%), instrument breakage (0.5%), transient lesions of the pudendus nerve (<1.5%).
髋关节中央和外周间隙的关节镜检查是髋关节镜检查的必要部分，用于评估、确认或发现病变及其治疗方法。
游离体、盂唇和股骨头韧带损伤、软骨损伤、股骨髋臼撞击症、滑膜疾病、早期骨关节炎、股骨头坏死（ARCO 1-2期）及粘连。
局部感染、关节附近的骨肿瘤、广泛的关节周围骨化、伴有关节周围受累的严重关节纤维化、晚期骨关节炎、髋臼前突、晚期股骨头坏死（从ARCO 3-4期扩展）、髋臼近期骨折及广泛的关节囊撕裂。
患者在骨折手术台上的精确体位对于避免并发症至关重要。中央和外周间隙关节镜检查至少需要2个，某些情况下超过3个切口。中央间隙的关节镜检查在通过前外侧（AL）和前侧切口（A）进行牵引的情况下进行。可能还需要后外侧（PL）切口和远侧腹外侧切口（DVL）。对于外周间隙关节镜检查，在髋关节屈曲45°且无牵引的情况下建立前外侧（AL）和前侧（A）切口，或者/附加地建立近端腹外侧切口（PVL）和/或远侧腹外侧（DVL）切口。
术后当天即可进行全负重活动，拐杖可选择使用。在刺激软骨手术或自体软骨细胞移植后，术后第6周结束前需使用拐杖进行10公斤的部分负重。除盂唇修复外，术后第1天即可进行允许全范围活动的物理治疗。
2010年1月至2019年12月，共进行了2815例髋关节镜检查；患者平均年龄43岁（12-81岁）。所有手术均包括髋关节的诊断性关节镜检查。使用了2至5个切口。平均手术时间为70分钟（18-48分钟）。在26例（0.9%）病例中，即使之前对外周间隙进行了关节镜检查并松解了关节囊，也无法或未进行高CE角的中央间隙关节镜检查。术中或术后直接出现的问题和并发症很少见, 例如，因接触压力导致皮肤/生殖器损伤（0.7%）、器械断裂（0.5%）、阴部神经短暂损伤（<1.5%）。
