髋关节镜术前关节联合松解可减少髋关节牵引时的牵引力。
Joint Venting Prior to Hip Distraction Minimizes Traction Forces During Hip Arthroscopy.
机构信息
Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.
School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A.
出版信息
Arthroscopy. 2021 Jul;37(7):2164-2170. doi: 10.1016/j.arthro.2021.02.015. Epub 2021 Feb 23.
PURPOSE
This study evaluates the effect of venting on distraction of the hip during arthroscopy on a post-free traction table for fixed traction forces ranging from 0 to 100 pounds (lbs).
METHODS
Patients underwent surgery by the senior author (S.K.A.) between November 2018 and July 2019. Inclusion criteria were primary hip arthroscopy requiring central compartment access. Patients were positioned in 10-15° Trendelenburg on a post-free traction table. Prior to instrumentation, fluoroscopic images of the operated hip joint were taken at 25-lb intervals from 0 to 100 lbs of axial traction. Traction was released for 15 minutes. Venting with 20 mL of air was performed and fluoroscopic images were repeated at all traction intervals. Joint displacement was measured at all intervals. An unvented control group underwent the same axial traction protocol for comparison.
RESULTS
Sixty-one consecutive patients underwent study protocol. Fifty-eight hips in 57 patients were included. Thirty-two (55.2%) were female; mean age was 31 ± 13 years and mean body mass index was 25.7 ± 6.2. Paired samples analysis demonstrated mean differences in distraction distance prior to and after venting of 0.27, 2.60, 4.09, 4.54, and 2.31 mm at 0, 25, 50, 75, and 100 lbs of traction, which were significant (P < .001) at all traction intervals. Significantly more vented hips distracted at least 10 mm at 25-100 lbs traction (P ≤ .001). An unvented control group showed no significant differences between the first and second traction application.
CONCLUSIONS
Venting prior to applying traction on a post-free traction table increases the distraction distance achieved for a given traction force at multiple levels of traction in comparison to the pre-vented state. Our results suggest venting the hip joint prior to the application of traction may serve to reduce the maximal amount of traction required to safely instrument the hip arthroscopically.
LEVEL OF EVIDENCE
IV, case series.
目的
本研究评估了在固定牵引力为 0 至 100 磅（磅）的免牵引台进行关节镜检查时，放气对髋关节牵开的影响。
方法
患者由资深作者（S.K.A.）于 2018 年 11 月至 2019 年 7 月期间进行手术。纳入标准为需要中央间隙入路的原发性髋关节镜检查。患者在免牵引台的 10-15°Trendelenburg 位上进行定位。在器械置入之前，对手术髋关节进行透视图像拍摄，从 0 至 100 磅的轴向牵引以 25 磅的间隔进行，然后释放牵引 15 分钟。对 20 毫升空气进行放气，在所有牵引间隔重复拍摄透视图像。在所有间隔测量关节位移。一个未放气的对照组进行相同的轴向牵引方案进行比较。
结果
61 例连续患者进行了研究方案。57 例患者中有 58 髋入组。32 例（55.2%）为女性；平均年龄为 31 ± 13 岁，平均体重指数为 25.7 ± 6.2。配对样本分析表明，放气前后牵开距离的平均差异为 0、25、50、75 和 100 磅牵引时的 0.27、2.60、4.09、4.54 和 2.31 毫米，在所有牵引间隔均具有显著差异（P <.001）。在 25-100 磅的牵引下，有更多的放气髋关节至少牵开 10 毫米（P ≤.001）。一个未放气的对照组显示，在第一次和第二次牵引应用之间没有显著差异。
结论
与未放气状态相比，在免牵引台施加牵引之前进行放气可增加在多个牵引水平上达到的牵开距离，与预先放气状态相比。我们的结果表明，在施加牵引之前对髋关节进行放气可能有助于减少安全进行髋关节关节镜手术所需的最大牵引量。
证据等级
IV，病例系列。
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