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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 231 -235. doi: 10.3877/cma.j.issn.1674-134X.2022.02.015

临床经验

保留髂股韧带的关节囊纵切在关节镜手术中的应用
殷庆丰1, 李岩2, 傅英强3, 赵恒1, 刘文广1, 王韶进1,()   
  1. 1. 250033 济南,山东大学第二医院关节外科/运动医学科
    2. 262199 潍坊,安丘市人民医院骨关节外科
    3. 250033 济南,山东大学第二医院关节外科/运动医学科;250012 济南,山东大学齐鲁医学院
  • 收稿日期:2021-08-30 出版日期:2022-04-01
  • 通信作者: 王韶进

Clinical application of longitudinal capsulotomy with iliofemoral ligament preserved in hip arthroscopy

Qingfeng Yin1, Yan Li2, Yingqiang Fu3, Heng Zhao1, Wenguang Liu1, shaojin Wang1,()   

  1. 1. Department of Orthopedics, The Second Hospital of Shandong University, Shandong University, Jinan 250033, China
    2. Department of Orthopedics, Anqiu people’s hospital, Weifang 262199, China
    3. Department of Orthopedics, The Second Hospital of Shandong University, Shandong University, Jinan 250033, China; Cheelo Medical School, Shandong University, Jinan 250012, China
  • Received:2021-08-30 Published:2022-04-01
  • Corresponding author: shaojin Wang
引用本文:

殷庆丰, 李岩, 傅英强, 赵恒, 刘文广, 王韶进. 保留髂股韧带的关节囊纵切在关节镜手术中的应用[J]. 中华关节外科杂志(电子版), 2022, 16(02): 231-235.

Qingfeng Yin, Yan Li, Yingqiang Fu, Heng Zhao, Wenguang Liu, shaojin Wang. Clinical application of longitudinal capsulotomy with iliofemoral ligament preserved in hip arthroscopy[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(02): 231-235.

目的

介绍关节镜下保留髂股韧带的关节囊纵切技术,并汇报其初步临床结果。

方法

回顾山东大学第二医院运动医学科2018年10月至2019年10月期间的髋关节镜手术病例。纳入病例都采用由外向内纵向关节囊切开技术进行髋关节镜手术,并完成至少6个月临床随访。统计患者的一般资料,以及关节囊切开操作时间,牵引时间,手术总时间,术中是否透视,关节囊是否闭合等手术指标,统计术后并发症发生率。比较术前和术后髋关节功能评分,采用独立样本t检验进行统计分析。

结果

共纳入采用囊外纵切技术的髋关节镜手术病例62例,其中髋关节撞击症和临界发育不良引发的盂唇损伤病例共53例。采取关节纵切技术完成关节囊切开平均需要(12±4)min,手术中平均牵引的时间为(39±9)min,总手术时间为(127±15)min。30.6%的患者(19例)不需要术中透视定位辅助,72.6%的患者(45例)采用了关节囊闭合。无严重手术并发症,无再手术和翻修病例。术后6个月髋关节功能评分由术前的(45±10)分提高到术后的(77±9)分(t=17.889,P<0.001)。

结论

采用髋关节囊外纵向切开技术,配合关节囊的闭合管理,能够较好的维护关节囊的完整性,具有良好的手术安全性和肯定的临床疗效。

Objective

To introduce the longitudinal capsulotomy technique with preservation of the iliofemoral ligament and to report its preliminary clinical results.

Methods

The cases that underwent hip arthroscopic surgery in the Department of Sports Medicine of the Second Hospital of Shandong University between October 2018 and October 2019 were reviewed. All the included cases adopted the longitudinal capsulotomy technique and were followed up for at least six months. The patients’ informations were recorded, as well as the operation time of capsulotomy, traction time, total operation time, intraoperative fluoroscopy, whether the joint capsule was closed, and the incidence of postoperative complications. The preoperative and postoperative hip function scores were compared. Statistical analysis was performed with independent t test.

Results

A total of 62 cases were enrolled, among which the labral injury caused by hip impingement and borderline dysplasia of the hip were 53 cases. It took an average of (12±4)min to complete the capsulotomy with the longitudinal technique, and the average traction time during the procedure was (39±9) min; the total operation time was(127±15)min. Fluoroscopic positioning assistance was not required in 30.6% of the cases(19 cases), and closure of the joint capsule was performed in 72% of the cases(45 cases). There was no serious surgical complications, no reoperation, nor revision. The hip function score improved from (45±10)points before surgery to (77± 9)points six months after the surgery (t=17.889, P<0.001).

Conclusion

The use of a longitudinal incision technique outside the hip capsule, together with the closed management of the joint capsule, can better maintain the integrity of the joint capsule with good surgical safety and positive clinical outcome.

图1 髋关节镜手术体位和入路。图A为体位摆放;图B为入路标记
图2 髋关节镜下关节囊外纵切技术操作。图A为进入关节囊外间隙,可见囊周脂肪组织;图B为通过辨识股直肌返折头、臀中肌、髂关节囊肌等确定关节囊切开位置;图C为在髂股韧带内外侧束之间纵行切开关节囊,方向垂直股直肌返折头;图D为关节囊切开近端至盂唇,远端至股骨颈;图E为关节镜进入中央间室,可见盂唇损伤;图F为缝线锚钉修复盂唇;图G为进入外周间室可见头颈区骨性畸形;图H为股骨头颈区畸形打磨成型后;图I为两侧关节囊组织过线;图J为边对边闭合关节囊后
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