Wininger Austin E, Kraeutler Matthew J, Goble Haley, Cho Justin, Mei-Dan Omer, Harris Joshua D
Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.
Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
Arthrosc Tech. 2024 Jun 22;13(10):103077. doi: 10.1016/j.eats.2024.103077. eCollection 2024 Oct.
Hip arthroscopy is commonly performed to treat femoroacetabular impingement syndrome. A post-assisted arthroscopic hip preservation surgery approach provides joint distraction for central-compartment access. Owing to the location, compression of the post in the perineum may cause injuries to the pudendal nerve, perineal soft tissue, or genitourinary system. A postless technique significantly reduces the risk of these complications. Postless arthroscopy uses friction between the patient's torso and the table surface to permit distraction without the post. An air arthrogram, general anesthesia with muscle paralysis, and variable degrees of Trendelenburg positioning reduce the force needed for joint distraction. Early postless literature suggested Trendelenburg angles of approximately 15°, which may be disorienting to surgeons and compromise the precision and accuracy of the surgical procedure. With the described technique, hip arthroscopy can be effectively performed with a Trendelenburg angle of less than 5° in nearly every case. Understanding the physics of postless hip arthroscopy using free-body diagrams of inclined planes with friction permits surgeons to understand the required Trendelenburg angle of the bed, the force of traction for any patient given his or her body habitus, and the coefficient of static friction of the table surface to achieve a minimum amount of joint distraction.
髋关节镜检查常用于治疗股骨髋臼撞击综合征。一种辅助后关节镜下髋关节保留手术入路可为中央腔隙入路提供关节牵开。由于该体位的位置关系,会阴部的支柱压迫可能会导致阴部神经、会阴部软组织或泌尿生殖系统损伤。无支柱技术可显著降低这些并发症的风险。无支柱关节镜检查利用患者躯干与手术台表面之间的摩擦力,在无需支柱的情况下实现牵开。空气关节造影、肌肉松弛的全身麻醉以及不同程度的头低脚高位可减少关节牵开所需的力量。早期关于无支柱技术的文献建议头低脚高位角度约为15°,这可能会使外科医生迷失方向,并影响手术操作的精确性和准确性。采用所述技术,几乎在每种情况下,以小于5°的头低脚高位角度即可有效进行髋关节镜检查。利用带有摩擦力的斜面受力分析图来理解无支柱髋关节镜检查的物理原理,有助于外科医生了解所需的手术台头低脚高位角度、根据患者体型所需的牵引力量以及手术台表面的静摩擦系数,以实现最小程度的关节牵开。