Shah Shalin, Stavinoha Tyler, Nepple Jeffrey J, Crepeau Allison E, Carsen Sasha
Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, ON, Canada.
Children's Hospital of San Antonio, San Antonio, TX, USA.
J Pediatr Soc North Am. 2024 Apr 25;7:100064. doi: 10.1016/j.jposna.2024.100064. eCollection 2024 May.
Hip Arthroscopy in the pediatric and adolescent hip has evolved from its role as a diagnostic tool to a primary modality of management of variety of hip pathologies in children and adolescents. This article reviews current concepts and advances in hip arthroscopy in this population. We discuss the indications, techniques, outcomes, and complications of hip arthroscopy in children and adolescents. We explore the newer indications of hip arthroscopy in the treatment of SCFE (Slipped Capital Femoral Epiphysis) deformity correction, borderline hip dysplasia, septic arthritis, infantile developmental dysplasia, Perthes disease, and the existing and developing evidence. Finally, we address the challenges and future directions in research, education, and training, unique to the pediatric and adolescent population.
(1)Hip arthroscopy has significant surgical applications in the pediatric and adolescent population, and can be used to help address several intra-articular as well as extra-articular pathologies.(2)The indications and potential for arthroscopic interventions and associated arthroscopic techniques is growing and developing rapidly, along with improving technology, techniques, and training.(3)FAI (Femoro Acetabular Impingement) and labral pathology are the most common indications for surgery in the adolescent, and clinical outcome studies show excellent results. However, nonoperative optimization should be strongly emphasized before surgical consideration.(4)Hip arthroscopy is minimally invasive and relatively low risk, though main risks and complications to be aware of is the potential need for revision or further surgery, transient neuropraxia of the pudendal nerve, surgical site infection, implant/tool-related breakage or failure, failed surgery, and venous thromboembolism.(5)Continued research and innovation in the field of pediatric hip arthroscopy are essential for further improving outcomes and expanding treatment options for young patients with hip disorders, and more pediatric-specific clinical research is needed.
小儿及青少年髋关节镜检查已从作为诊断工具的角色发展成为治疗儿童和青少年多种髋关节疾病的主要方式。本文回顾了该人群髋关节镜检查的当前概念和进展。我们讨论了儿童和青少年髋关节镜检查的适应症、技术、结果及并发症。我们探讨了髋关节镜检查在治疗股骨头骨骺滑脱（SCFE）畸形矫正、临界性髋关节发育不良、化脓性关节炎、婴儿发育性髋关节发育不良、佩特兹病方面的新适应症，以及现有和正在形成的证据。最后，我们阐述了小儿及青少年人群在研究、教育和培训方面特有的挑战及未来方向。
（1）髋关节镜检查在小儿及青少年人群中有重要的手术应用，可用于处理多种关节内及关节外疾病。（2）随着技术、技巧和培训的改进，关节镜干预的适应症和潜力以及相关关节镜技术正在迅速发展。（3）股骨髋臼撞击症（FAI）和盂唇病变是青少年最常见的手术适应症，临床结果研究显示效果良好。然而，在考虑手术前应强烈强调非手术优化。（4）髋关节镜检查是微创的且风险相对较低，不过需要注意的主要风险和并发症是可能需要翻修或进一步手术、阴部神经短暂性神经失用、手术部位感染、植入物/工具相关的破损或故障、手术失败以及静脉血栓栓塞。（5）小儿髋关节镜领域持续的研究和创新对于进一步改善年轻髋关节疾病患者的治疗效果和扩大治疗选择至关重要，并且需要更多针对小儿的临床研究。
