Moran Thomas E, Taleghani Eric R, Gwathmey F Winston
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Video J Sports Med. 2021 Sep 21;1(5):26350254211025033. doi: 10.1177/26350254211025033. eCollection 2021 Sep-Oct.
Screw impingement is an infrequently reported sequelae following in situ pinning of a slipped capital femoral epiphysis, but it may result in significant bony and chondrolabral degeneration. Hip arthroscopy may offer the advantage of screw removal in a minimally invasive manner under direct visualization, as well as providing the opportunity for management of concomitant hip pathology.
A healthy, active 27-year-old woman with right hip dysfunction secondary to screw impingement and concomitant chondrolabral pathology following previous in situ pinning of a slipped capital femoral epiphysis.
The patient elected to undergo arthroscopic removal of hardware, osteochondroplasty, and management of hip labrum pathology. After the screw was localized, a 2.8-mm pin was inserted down the cannulated center of the screw to prevent intraarticular displacement during removal. The screw and washer were removed intact, and femoroplasty was performed to remove the reactive bone and resolve the cam-type impingement. Acetabuloplasty was then performed to remove pincer-type impingement and provide an appropriate rim of bone for labral reconstruction. The pathologic labrum was then debrided and reconstructed with a semitendinosus allograft.
There were no immediate complications following surgery. Surgical management led to resolution of the patient's mechanical symptoms and provided pain relief, which allowed return to prior baseline level of function.
DISCUSSION/CONCLUSION: Symptomatic screws that impinge the osteochondral and soft tissue anatomy of the hip require removal. Historically, these screws have been removed by open, mini-open, or percutaneous techniques. This case demonstrates the advantages of arthroscopic removal, as it affords the surgeon the ability to perform a dynamic examination, safely remove the screw, and directly visualize and manage concomitant hip pathology that may not be otherwise be recognizable. Further studies will be required to determine the ability of this technique to more clearly illustrate long-term improvement in function and prevention of the development of osteoarthritis.
螺钉撞击是股骨头骨骺滑脱原位固定术后一种报道较少的后遗症，但它可能导致明显的骨质和盂唇退变。髋关节镜检查可能具有以微创方式在直视下取出螺钉的优势，同时也为处理合并的髋关节病变提供了机会。
一名27岁健康、活跃的女性，因既往股骨头骨骺滑脱原位固定术后螺钉撞击及合并盂唇病变而出现右髋关节功能障碍。
患者选择接受关节镜下取出内固定物、骨软骨成形术以及处理髋关节盂唇病变。确定螺钉位置后，将一根2.8毫米的克氏针沿螺钉的空心中心插入，以防止取出过程中关节内移位。完整取出螺钉和垫圈，然后进行股骨成形术以去除反应性骨质并解决凸轮型撞击。接着进行髋臼成形术以消除钳夹型撞击，并为盂唇重建提供合适的骨质边缘。然后对病变的盂唇进行清创，并用半腱肌同种异体移植物进行重建。
术后无即刻并发症。手术治疗使患者的机械性症状得到缓解并减轻了疼痛，使其能够恢复到之前的基线功能水平。
讨论/结论：撞击髋关节骨软骨和软组织解剖结构的有症状螺钉需要取出。以往，这些螺钉通过开放、微创或经皮技术取出。本病例展示了关节镜下取出的优势，因为它使外科医生能够进行动态检查、安全取出螺钉，并直接观察和处理可能无法通过其他方式识别的合并髋关节病变。需要进一步研究来确定该技术更清楚地说明功能长期改善以及预防骨关节炎发展的能力。
