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编辑评论:髋关节 CAM 过度切除可能导致不良结果:是太少、太多还是刚刚好?金伯利悖论

Editorial Commentary: Hip Cam Overresection May Result in Inferior Outcomes: The Goldilocks Paradox of Too Little, Too Much, or Just Right?

出版信息

Arthroscopy. 2021 Sep;37(9):2817-2819. doi: 10.1016/j.arthro.2021.06.010.

Abstract

Femoroacetabular impingement is a recognized source of hip pain and cause of labral and articular cartilage injury. Persistent femoroacetabular impingement has been recognized as a source of inferior patient-reported outcomes, and attempts to define a "normal" α-angle has resulted in more aggressive resection of cam lesions. An overzealous femoroplasty may result in iatrogenic hip instability. A dynamic intraoperative examination may be the best way to truly recognize this problem, in particular, by visualizing the loss of the suction seal, as the cam resection engages the acetabulum, resulting in subluxation. A soft tissue "remplissage" salvage procedure may offer an option to correct cam overresection and improve patient outcomes during revision arthroscopy, as we continue to search for the "right" amount of cam correction to perform.

摘要

髋关节撞击症是髋关节疼痛的一个公认病因,也是导致盂唇和关节软骨损伤的原因。持续性髋关节撞击症被认为是导致患者预后不良的一个原因,人们试图定义一个“正常”的 α 角,这导致了更激进的凸轮病变切除术。过度的股骨成形术可能导致医源性髋关节不稳定。术中动态检查可能是真正识别这个问题的最佳方法,特别是通过观察到抽吸密封的丢失,因为凸轮切除与髋臼相接合,导致半脱位。软组织“填充”挽救手术可能为纠正凸轮过度切除和改善翻修关节镜检查中的患者结果提供一种选择,因为我们继续寻找要进行的“正确”凸轮矫正量。

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