Ingoldby C J
Department of Surgery, Pinderfields Hospital, Wakefield UK.
Br J Surg. 1997 Feb;84(2):213-5. doi: 10.1046/j.1365-2168.1997.02460.x.
Musculotendinous groin disruption is common in professional sportsmen. Diagnosis is difficult and management complicated by strong desires for early return to sporting activity. The possible role of laparoscopic repair in promoting early recovery was examined.
A series of patients with persistent pain that prevented sport for more than 3 months were treated surgically. Thirty repairs were performed on 28 players, 18 professional and nine amateur. Seventeen injuries were sustained playing rugby league, seven association football and four other sports. There were 14 conventional repairs (11 Lichtenstein) and 14 laparoscopic (two bilateral). All patients were discharged within 24 h.
No player complained of severe postoperative pain. Seven of 14 patients who had laparoscopic repair denied experiencing any pain at all. Training was resumed within 4 weeks for nine of 14 patients who had a conventional repair and 13 of 14 who underwent laparoscopic repair. Full contact training restarted at a median 5 (range 1-6) weeks for conventional and 3 (range 1-9) weeks for laparoscopic repair (P < 0.05). Two players had persistent neuralgia after laparoscopic repair which settled by 2 months. One player had recurrent pain 5 months after laparoscopic repair, and one had a recurrent hernia 22 months after conventional repair. There were no wound problems.
Laparoscopic repair appears as effective as conventional repair for sporting injuries, and merits further evaluation as a technique to permit early return to activity.
肌腱腹股沟损伤在职业运动员中很常见。诊断困难,且因运动员强烈渴望早日重返运动而使治疗复杂化。研究了腹腔镜修复在促进早期恢复中的可能作用。
对一系列因持续疼痛而无法运动超过3个月的患者进行手术治疗。对28名运动员进行了30次修复,其中18名职业运动员,9名业余运动员。17例损伤发生在橄榄球联盟比赛中,7例在足球比赛中,4例在其他运动中。进行了14例传统修复(11例Lichtenstein修补术)和14例腹腔镜修复(2例双侧)。所有患者均在24小时内出院。
没有运动员抱怨术后疼痛严重。14例接受腹腔镜修复的患者中有7例根本没有疼痛。14例接受传统修复的患者中有9例在4周内恢复训练,14例接受腹腔镜修复的患者中有13例恢复训练。传统修复患者全接触训练恢复的中位时间为5周(范围1 - 6周),腹腔镜修复患者为3周(范围1 - 9周)(P < 0.05)。2名运动员在腹腔镜修复后出现持续性神经痛,2个月后缓解。1名运动员在腹腔镜修复后5个月出现复发性疼痛,1名运动员在传统修复后22个月出现复发性疝。没有伤口问题。
对于运动损伤,腹腔镜修复似乎与传统修复一样有效,作为一种能使患者早日恢复活动的技术,值得进一步评估。