髋关节镜术的的入路选择.pdf

·论　著· 髋关节镜术的入路选择 吴海山 　李晓华 　徐青镭 　吴宇黎 　钱齐荣 　　摘 　要 　目的 :探讨髋关节镜手术不同入路的可见视野和操作安全性。方法 :使用三点入路 ,2 个入路分别位于大 粗隆的外侧上方 ,1 个入路位于前方。使用 30/ 70 镜头并更换镜头入路 ,记录关节镜下视野。通过 18 例髋关节镜检查和 手术操作过程及并发症分析 ,评价不同髋关节镜入路的有效性和安全性。结果 :本研究显示 ,以 30°/ 70°标准关节镜经髋 关节前方及侧方入路 ,可确切观察到的髋关节结构包括 :髋臼上部的负重区 ,陷窝及圆韧带 ,上、前、外侧的髋臼盂唇 ;通 过手术中台下外旋和内旋髋关节 ,可以观察到大部分股骨头关节面。本组未出现神经血管并发症。结论 :经由 3 个入路 相配合交替使用镜头和手术器械 ,可以完成关节镜的系统检查与手术操作。该入路的操作具有安全、有效和可重复性。 关键词 　关节镜 ; 　髋关节 ; 　关节镜入路 ; 　解剖 中图分类号 　R687. 4 　　　文献标识码 　A 　　　文章编号 　1005 - 8478 (2001) 08 - 0768 - 03 Choice of Portal Route for Hip Arthroscopy ∥W U Hai2shan , L I Xiao2hua , XU Qing2lei , et al . Depart ment of Or2 thopaedics Changz heng Hospital , S hanghai 200003 Abstract 　Objective : To explore the hip arthroscopic visualization through different portals and its reliability during the op2 eration. Methods : Three arthroscopic portals are routinely used. Two portal are placed laterally over the superior aspect of the greater trochanter ,and one is placed anteriorly. Using 30 degree and 70 degree arthroscope ,and changing the portals ,the arthro2 scopic sight had been recorded for a series of 18 cases who underwent hip arthroscopy. Based on analysis of these procedures and complications in this series ,we try to evaluate the effectiveness and reliability of these hip arthroscopic portals. Result : From this study ,by utilizing both 30 and 70 video - arthroscopes through the anterior and lateral portals ,the structures that can depend2 ably be visualized include :the superior weitht bearing portion of the acetabulum ;the fossa ;the ligament ;and the anteror ,posteri2 or and lateral aspects of acetabulum labrum. Most of the weight bearing articular portion of the femoral head can be visualized in2 traoperatively by internally and externally rotating the hip . No neurovscular complications took place in this series. Conclusion : Systematic examination and operative arthroscopy of the hip are facilitated by interchanging the instruments and arthroscope be2 tween the three establ