hip arthroscopy

In 1931, Burman first introduced the concept of hip arthroscopy. In 1971, Gross reported the use of arthroscopy to treat congenital dislocation of the hip. The concept of hip arthroscopy reappeared in the North American literature. In the early 1980s, there were sporadic literature reports on the clinical application of hip arthroscopy. In recent years, reports on the use of arthroscopy for the treatment of hip joint diseases have gradually increased and attracted widespread attention. Treatment of diseases: hip bursitis, hip tuberculosis Indication Free hip joint, labral tear, acetabular or femoral head cartilage, avascular necrosis of the femoral head, rupture or impact of the round ligament, acetabular dysplasia, synovial disease, collagen disease (eg rheumatoid arthritis or system) Lupus erythematosus with impulsive synovitis), crystalline hip joint disease (eg gout, pseudogout), joint capsule contracture (eg Ehers-Danlos syndrome), synovial chondromatosis, blood disease, infection, total Foreign body removal after hip arthroplasty (diagnosis of recessive infection, removal of intra-articular wire or bone cement foreign body), post-traumatic disease (dislocation, Pipkin fracture), osteoarthritis, extra-articular disease, and refractory hip joint pain, Arthroscopic surgery can be performed and treated. Patients with a history of trauma are more suitable for arthroscopic diagnosis and treatment. Patients with symptoms such as shackles and tingling are more suitable for microscopic joint removal than patients with joint pain or limited mobility due to pain. Hip pain caused by long-term recurrent episodes and persistent symptoms can not be relieved. Patients with positive signs but not clearly diagnosed can also be treated with hip arthroscopy. Contraindications Hip ankylosis, severe osteoarthritis, progressive destruction of the hip joint, skin disease and ulcer adjacent to the anterior or lateral entrance, femoral neck stress fracture, ischial pubic symphysis fracture and osteoporosis, intra-articular fiber adhesion and joint Cyst contracture, joint stiffness; ectopic bone formation and severe acetabular retraction, the joint can not be retracted or filled, arthroscopy instruments can not enter; traumatic or surgically caused abnormal anatomical abnormalities of the hip bone and soft tissue; sepsis Patients with osteomyelitis or abscess formation need to be cut open; joint retraction limited disease; morbid obesity, the device is difficult to reach the joint, difficult to perform surgical operations. Preoperative preparation 1. The conventional spare C-shaped or G-arm X-ray image intensifier is very important to ensure an accurate and correct approach. 2. Must have 30° and 70° arthroscopy, cold light source, camera imaging system, monitor arthroscope, manual instrument and electric cutting planing system, RF. The general 30° arthroscopy is best for observing the central part of the acetabulum and the upper part of the femoral head and acetabular fossa. The 70° arthroscopy showed the best effect on the peripheral part of the joint, the acetabular lip and the lower part of the acetabular fossa. Use these two arthroscopes alternately to get the best image. 3. Mechanical liquid pressure pumps have advantages in maintaining water flow, and if the water pressure is too large, the lavage fluid may leak. The high-flow lavage fluid control system produces sufficient water flow without excessive pressure. 4. Fully-lengthened arthroscopic sleeves with diameters of 4.5mm, 5.0mm and 5.5mm. The cannula, the puncture cone and the guide wire are matched with the instrument, and the guide wire enters the joint through a special 17-inch 6-inch puncture needle. 5. In order to adapt to the spherical surface shape of the femoral head, a special long curved cutting tool. 6. Extended surgical instruments and specially lengthened plasma scalpels help with arthroscopic surgery. Surgical procedure 1. Preoperative body surface positioning The femur large trochanter is drawn, marking the bony marks around the hip joint, vascular nerve walking, arthroscopy and instrument entrance. 2. Hip puncture with a special 18-cm long puncture needle. The puncture needle is inserted along the apex of the femoral trochanter and penetrates into the hip joint along the acetabular rim. After successful hip puncture, the saline in the syringe connected to the puncture needle is automatically inhaled into the hip joint cavity. The fluid injected into the hip joint cavity will automatically flow back, indicating that the needle is already in the hip joint cavity. 3. Use a syringe to inject 10 to 15 ml of water into the joint to break the negative pressure suction seal in the joint. The hip joint will relax and can be further retracted. 4. Insert the guide wire into the puncture needle and pull out the puncture needle. A 5 mm diameter hollow core guide rod was inserted into the joint cavity along the guide needle, and the puncture cone sleeve was inserted through the guide rod through the joint cavity. 5. After the working channel is established, the arthroscope is placed. Under the observation of the 70° arthroscopy, under the free edge of the labrum, the 17th lumbar puncture needle is inserted into the joint cavity to explore the path, and then the puncture cannula is inserted. Within the hip joint, away from the articular surface of the femoral head. 6. The surgical approach is generally three surgical approaches: the anterior, anterolateral, and posterolateral approach. complication Neurovascular traction injury, perineal crush injury, femoral head and labrum injury, trochanteric bursitis, excessive soft tissue of the hip joint, surgical instrument fracture, etc. The possible complications of the lateral approach are due to traction. Compression of the pudendal nerve branch of the ischial and traction of the sciatic nerve. The femoral artery and femoral nerve are located on the medial side of the anterior approach, the lateral femoral cutaneous nerve is adjacent to the anterior approach, and the sciatic nerve is located posterior to the posterolateral approach. When determining the approach, neurovascular travel should be considered. Important anatomical structures near the lateral approach include the posterior sciatic nerve and the anterior lateral femoral cutaneous nerve. There are femoral, femoral and gluteal nerves in front of the entrance, pay attention to its position to avoid damage.