Transcript Höftartroskopi - Oslo universitetssykehus

Höftartroskopi
Hossein Ghaffari
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Höftartroskopi
• Historisk
• Symptom-lokalisation
• Indikation
• Undersökning
• Röntgenundersökning
• Artroskopiteknik
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Höftartroskopi
Burman JBJS 1931
First published report
↵ Burman MS. Arthroscopy or the direct
visualization of joints: an experimental cadaver
study. J Bone Joint Surg1931;29:669–95.
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Historik
•1931 Burman
Arthroscopy or The direkt visualzation of joints
Kadaverstudie
" it is menifestly impossible to put à
needle into The hip joint"
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Höftartroskopi
Lever of acceptans began in
1980
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1990 Villar utvecklade
tekniken
Historik
• 1995 Byrd bra
artroskopiportaler
• ↵ Byrd JW. Hip arthroscopy.
The supine position. Clin
Sports Med2001;20:703–31
• 2004 Dienst bättre
upplänning
• Philipon modifierad
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Höftartroskopi
• Inte så vanligt
• Svårt på grund av
• Stram led
• Svårt att gå runt pga muskel, kapsel, ligament
• Risk för nerv-kärl skador
• Bättre instrument
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Hip arthroscopy: current concepts and review of
literature
Vijay D Shetty1, Richard N Villar2
1LH Hiranandani Hospital, Mumbai, India
2Cambridge Hip and Knee Unit, Cambridge, UK
Correspondence to:
Vijay D Shetty
LH Hiranandani Hospital, Powai, Mumbai 400076,
India; [email protected]
Accepted 28 August 2006
Published Online First 30 November 2006
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• Smärtsam clicking
Symptom
• Låsning
• Ljumsk smärta
• Giving way
• Svaghet
• Stelhet
• Inskränkt rörelse
• Smärta runt höftleden ( c-sign).
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Symptom vid fri kropp
• Låsning
• Ljumsk smärta
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Symptom vid Labrum skada
• Ljumsk smärta
• Smärtsam click
• Låsning
• Giving Way
• Positiv Thomas extension
test
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Symptom vid brosk skador
• Ljumsk smärta
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Symptom vid synovitis
• Smärta
• Svårt att diagnosticera
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• FABER (bakre impingment).
• F lektion
• AB duktion
• E xternal
• R otation
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Undersökning
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Radiologisk undersökning
• Skelett röntgen
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"Launstein"
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Radiologisk undersökning
• Skelett röntgen
• Artrografi
• MRT
• MRT + Gadolinium
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A.R. Altenberg
Acetabular labrum tears: A cause of hip pain
and degenerative arthritis
South Med J, 70 (1977), pp. 174–175
A.L. Lage, J.V. Patel, R.N. Villar
The acetabular labral tear: An arthroscopic
classification
Arthroscopy, 12 (1996), pp. 269–272
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Acetabulär
Impingment)
Höftartroskopi
• Labrumskador
Indikationer
• Fria kroppar i
höftleden
• Septisk Artrit
• Ligmentum teres
skada
• Ledyteskador
• osteochondritis
dissecans
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Höftartroskopi
Position
• Supine- Byrd -94
• Lateral- Glick- 87
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Höftartroskopi
• Spinal/generell ans.
• Sträckbord.
• Genomlysning.
• Identifiera trochanter
major.
• Rita ut portaler på
huden
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Portals:
Distance from portal to
anatomic structures Byrd,
Arthroscopy, 1995, 11(4)
Lateral
Anterolateral
Posterolateral
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Distance from portal to anatomic
structures Byrd, Arthroscopy, 1995, 11(4)
• Anterior portal
• ASIS- 6.3 cm
• LFCN- 0.3 cm
• Se anteriort, superiort,
Lig Terese
• 70 scope
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Anterior Paratrochanteric Portal
(Anterolateral)
• 2-3 cm anteriort & 1 cm
proximalt to trokanter
major
• Om för mycket anteriort
kan skada NV
• Labrum, caput femoris,
fovea
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Posterior Paratrochanteric Portal
(Posterolateral)
• 2-3 cm posteriort om
trochanter major
• Nervus Ishias
• Posteriort kapsel
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Höftartroskopi
• Höftleden placeras i lätt
flexion, abduktion och
utåtrotation.
• Optimal Traktion i
collums riktning
• 25 kg Traktion < 2 Tim
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Höftartroskopi
• Punktera leden
/anterolateral portal
• Släpp på vakuumet
• Distraktion av
höftled
• Ca 1 cm distans
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Höftartroskopi
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Höftartroskopi
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Höftartroskopi
• Guide-pinnen genom
anterolat portal
• För in skopet över
pinnen
• Under uppsikt innifrån &
med genomlysning
tillverka abetsportaler
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Höftartroskopi
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Höftartroskopi
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Komplikationer
Traction skador
•Transient nerv skador(pudendal, sciatic)
•Tryck nekrosis
Direkt nevrovaskulär skada
Iatrogen brosk skada
Iatrogen Labrum skada
Instrument skada
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Dorfmann and Boyer, “Arthroscopy of the Hip: 12 Years
of Experience,” Arthroscopy, Vol. 15, No. 1, 1999, 6772.
w Labral
lesions commonly overestimated at
arthrography. Only 18 cases of 413
confirmed arthroscopically (4.4%)
w 93 of 103 arthroscopies for chondromatosis
were therapeutic (90.3%)
w 55 normal hip scopes 13.3% – too high
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Dorfmann and Boyer, “Arthroscopy of the Hip: 12 Years
of Experience,” Arthroscopy, Vol. 15, No. 1, 1999, 6772.
w Mixed
traction technique
w Indications:
– Undiagnosed hip pain despite complete work-up
– Undiagnosed catching or locking of the hip
w Diagnostic arthroscopy especially beneficial for
biopsy specimens in inflammatory synovitis, etc.
w Removal of loose bodies is main therapeutic
indication
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Lage, Patel, and Villar, “The Acetabular Labral Tear: An
Arthroscopic Classification,” Arthroscopy, Vol. 12, No. 3,
1996, 269-272.
w
267 hip scopes
w 37 labral tears
w 4 Etiologies:
– Traumatic (7) – clear history
with no degen cartilage
changes
– Degenerative (18) – if
degenerative changes present
in cartilage or labrum
– Idiopathic (10)
– Congenital (2) - two
subluxing labra which were
functionally abnormal
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Lage, Patel, and Villar, “The Acetabular Labral Tear: An
Arthroscopic Classification,” Arthroscopy, Vol. 12, No. 3,
1996, 269-272.
w
Morphological Classification
– Radial Flap (21)
– Radial Fibrillated (8)
– Longitudinal Peripheral (6)
– Unstable (2)
w
62% tears on anterior labrum
w No correlation of tear type and
location associated
w No mention of outcomes
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Farjo, Glick, & Sampson, “Hip Arthroscopy for
Acetabular Labral Tears,” Arthroscopy, Vol 15, No. 2,
1999, 132-137.
w Retrospective
review of 28 labral tears with
min. of one year of follow-up with
subjective outcome analysis.
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Farjo, Glick, & Sampson, “Hip Arthroscopy for
Acetabular Labral Tears,” Arthroscopy, Vol 15, No. 2,
1999, 132-137.
w Presenting
symptoms
– 36% recalled a specific event
– 64% with mechanical symptoms
– 57% described clicking
– 18% described locking
– 14% giving way
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Farjo, Glick, & Sampson, “Hip Arthroscopy for
Acetabular Labral Tears,” Arthroscopy, Vol 15, No. 2,
1999, 132-137.
w Arthroscopic
Findings
– 17 tears of anterior labrum
– 7 tears of posterior labrum
– 4 tears of superior labrum
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Farjo, Glick, & Sampson, “Hip Arthroscopy for
Acetabular Labral Tears,” Arthroscopy, Vol 15, No. 2,
1999, 132-137.
w Complications
– 2 Sciatic nerve palsies
– 1 Pudendal nerve palsy
– All resolved sponteously without sequelae
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↵ Ganz R, Parvizi J, Beck M, et al. Femoroacetabular
impingement: a cause for osteoarthritis of the hip. Clin
Orthop 2003;417:112–20.
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↵ Ganz R, Parvizi J, Beck M, et al.
Femoroacetabular impingement: a cause for
osteoarthritis of the hip. Clin Orthop
2003;417:112–20.
Tack
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