Kraeutler Matthew J
Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center, Lubbock, Texas, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Dec 12;7(1):101068. doi: 10.1016/j.asmr.2024.101068. eCollection 2025 Feb.
Traditionally, distraction of the hip joint during hip arthroscopy has been achieved with the use of a perineal post, which acts as a counterforce. However, our knowledge of the potential complications related to the use of a perineal post continues to grow. Although pudendal neurapraxia is the most common of these potential complications, the perineal post also may cause skin tears of the perineum, erectile dysfunction and, in rare cases, permanent pudendal nerve injury. In response, several techniques for performing postless hip arthroscopy have been developed in recent years. Although some of these techniques are commercially available and some are "do-it-yourself," preliminary evidence has shown minimal risk of groin-related complications with these postless techniques. In addition to reducing complication rates, our research revealed significantly better patient-reported outcomes with postless compared with post-assisted hip arthroscopy at a minimum 1-year follow-up. Groin-related complications during hip arthroscopy are confusing and anxiety-producing to patients. Hip arthroscopy is an elective procedure, and patients do not expect to have any groin symptoms after a hip surgery. Because this is a sensitive issue, the potential for groin-related complications is rarely discussed with patients preoperatively. In addition, patients often are confused and reluctant to mention groin-related complications to their surgeon, especially if these symptoms are short-lived. Postless hip arthroscopy is a readily accessible, safe alternative to using a perineal post and should be adopted as the standard of care sooner rather than later.
传统上，髋关节镜检查时髋关节的牵引是通过使用会阴柱来实现的，会阴柱起到反作用力的作用。然而，我们对与会阴柱使用相关的潜在并发症的认识在不断增加。虽然阴部神经失用症是这些潜在并发症中最常见的，但会阴柱也可能导致会阴皮肤撕裂、勃起功能障碍，在极少数情况下，还会导致永久性阴部神经损伤。作为应对措施，近年来已开发出几种无柱髋关节镜检查技术。虽然其中一些技术有商业产品可供使用，还有一些是“自己动手做”的，但初步证据表明，这些无柱技术导致腹股沟相关并发症的风险极小。除了降低并发症发生率外，我们的研究还显示，在至少1年的随访中，与有柱辅助髋关节镜检查相比，无柱髋关节镜检查在患者报告的结果方面明显更好。髋关节镜检查期间的腹股沟相关并发症会让患者感到困惑并产生焦虑。髋关节镜检查是一种择期手术，患者并不期望髋关节手术后出现任何腹股沟症状。由于这是一个敏感问题，术前很少与患者讨论腹股沟相关并发症的可能性。此外，患者通常会感到困惑，不愿意向外科医生提及腹股沟相关并发症，尤其是如果这些症状持续时间较短。无柱髋关节镜检查是一种容易获得的、安全的替代会阴柱使用的方法，应尽早作为护理标准采用。
