Larson Christopher M
Edina, Minnesota, U.S.A.
Arthroscopy. 2023 Mar;39(3):748-750. doi: 10.1016/j.arthro.2022.11.017.
Recently, there has been a trend toward performing hip arthroscopy without a post (postless) in an effort to decrease perineal post-related complications. Previous studies have revealed a variable risk of pudendal nerve neuralgia and perineal soft-tissue injury when using a post. There is emerging evidence that arthroscopic hip procedures can be done without the use of a post, with less traction force on the perineal region, and with adequate exposure to safely accomplish a well-done femoroacetabular impingement corrective procedure. Prospective comparative studies with conclusive evidence of the superiority of either technique, however, are lacking. Complications with a post are likely associated with high traction forces, prolonged traction times, and potentially suboptimal technique and patient positioning. In addition, postless traction is in its infancy and new adverse events/outcomes are likely to emerge. There are likely specific situations and patient populations in which one technique might be superior to the other. We are the carpenters of medicine and rather than blaming our tools and throwing out a technique that has served us well for decades, we should better understand some important pearls and pitfalls that might allow either method to be safely performed.
最近，有一种趋势是进行无支柱（无柱）髋关节镜检查，以减少与会阴支柱相关的并发症。先前的研究表明，使用支柱时阴部神经痛和会阴软组织损伤的风险各不相同。越来越多的证据表明，关节镜下髋关节手术可以在不使用支柱的情况下进行，对会阴区域的牵引力较小，并且有足够的视野来安全地完成良好的股骨髋臼撞击矫正手术。然而，缺乏具有确凿证据证明哪种技术更具优势的前瞻性比较研究。使用支柱的并发症可能与高牵引力、延长的牵引时间以及潜在的技术和患者体位欠佳有关。此外，无支柱牵引尚处于起步阶段，可能会出现新的不良事件/结果。可能存在某些特定情况和患者群体，其中一种技术可能优于另一种。我们是医学的木匠，与其指责我们的工具并摒弃一种已经为我们服务数十年的技术，我们应该更好地理解一些重要的要点和陷阱，以便能够安全地实施任何一种方法。
