Floerkemeier T, Ezechieli M, Wirries N, Windhagen H, Ribas M, Budde S
go:h Gelenkchirurgie Orthopädie Hannover, Bertastr. 10, 30159, Hannover, Deutschland.
Medizinische Hochschule Hannover - Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
Oper Orthop Traumatol. 2022 Apr;34(2):117-128. doi: 10.1007/s00064-021-00755-2. Epub 2021 Dec 14.
Treatment of pathologies of the central and peripheral compartment of the hip using arthroscopic assisted mini-open arthrotomy via the Smith-Petersen approach.
Cam- and pincer-type femoroacetabular impingement (FAI), labral tear, loose bodies.
(RELATIVE) CONTRAINDICATIONS: Osteoarthritis of the hip with Tönnis classification grade ≥ 2.
After mini-open approach to the hip joint via direct anterior muscular gap, the anterior capsule is split with protection of the labrum. Decompression allows the joint to be inspected using an arthroscope. Depending on the intra-articular findings, additional procedures can be performed (e.g., curettage of the cartilage, microfracturing, matrix-induced autologous chondrocyte implantation [MACI]). Cases with pincer-type FAI or labral tear can also be addressed. After partial release, the cam-type FAI can be resected using a surgical burr.
Partial weightbearing for 2-6 weeks with 10-20 kg or half body weight using crutches depending on the intraoperative treatment.
Radiological analysis of the pre- and postoperative X‑rays (n = 69) prove that this surgical technique is suitable to address pathologies especially FAI syndromes. The α‑angle according to Nötzli could be reduced from a mean preoperative value of 72.8° to 49.4° postoperative. In combined cam-type and Pincer-type FAI syndrome (n = 16), the lateral center-edge angle could be reduced from a mean preoperative value of 50.2° to 37.6° postoperatively. The clinical follow-up (n = 29) revealed good midterm outcomes after arthroscopic assisted mini-open arthrotomy (modified Harris Hip Score [mHHS] 84.8 points after 4.9 years [range 4.2-5.7; ±0.43]).
采用经史密斯-彼得森入路的关节镜辅助小切口切开术治疗髋关节中央和周围间隙的病变。
凸轮型和钳夹型股骨髋臼撞击症（FAI）、盂唇撕裂、游离体。
（相对）禁忌证：Tönnis分级≥2级的髋关节骨关节炎。
经直接前方肌肉间隙对髋关节进行小切口入路后，在保护盂唇的情况下切开前方关节囊。减压后可使用关节镜检查关节。根据关节内检查结果，可进行其他手术操作（如软骨刮除、微骨折、基质诱导自体软骨细胞植入[MACI]）。钳夹型FAI或盂唇撕裂的病例也可进行处理。部分松解后，可使用手术磨钻切除凸轮型FAI。
根据术中治疗情况，使用拐杖进行2 - 6周的部分负重，负重10 - 20千克或体重的一半。
对术前和术后X线片（n = 69）的影像学分析证明，该手术技术适用于治疗病变，尤其是FAI综合征。根据诺茨利法测量的α角可从术前平均72.8°降至术后49.4°。在凸轮型和钳夹型FAI综合征联合病例（n = 16）中，外侧中心边缘角可从术前平均50.2°降至术后37.6°。临床随访（n = 29）显示，关节镜辅助小切口切开术后中期效果良好（改良Harris髋关节评分[mHHS]在4.9年时为84.8分[范围4.2 - 5.7；±0.43]）。
