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深部关节疼痛综合征:内镜方法的技术描述和解剖学的考虑

Carlos Tobar^1,2,3, José T Bravo^4,5, Diego Villegas^1,2

¹Department of Orthopaedic Surgery, Clínica RedSalud Providencia, Santiago, Chile.

JBJS essential surgical techniques

|July 9, 2025

概括

这项研究提出了深关节疼痛综合征的内镜技术,成功地治疗了纤维血管带和毛囊,而不需要皮皮形状的切断. 最少侵入性的方法为患有这种具有挑战性的疾病的患者提供了良好的到优秀的结果.

科学领域:

整形外科手术整形外科手术
最少侵入性手术的方法
疼痛管理疼痛管理

背景情况:

深部关节疼痛综合征通常是由纤维血管带引起的,由于解剖连续性,经常与过度缩的毛囊并存.
目前的管理包括解决周周腔空间 (切除术) 和后部空间 (纤维血管带切除术).
之前的技术有时需要皮里形切,增加了侵入性.

研究的目的:

展示使用修改的门户进行内镜技术,以完全管理深部关节疼痛综合征.
为了同时解决腹腔和下空间.
为了评估纤维血管带切除的有效性,而不是皮里形肌切除.

主要方法:

卧卧的患者定位允许自由操纵四肢以访问大三叉骨.
两个修改后侧辅助门户 (PPLA和DPLA) 被创建用于内镜访问.
该程序包括切除术,部分关节最大骨切除术,纤维血管粘附的释放和纤维血管带的切除.

主要成果:

该技术通过两个门户提供了通过两个门户进入腹腔和下空间的途径.
切除纤维血管带,而不是皮皮形状的切断,导致所有患者恢复了坐骨神经的外流和循环.
中期随访显示70%的良好到优秀的结果,mHHS,iHOT-12和VAS得分有所改善.

结论:

这种内镜技术为涉及两部分的深关节疼痛综合征提供了完整的解决方案.
它可以有效地管理纤维血管带和毛囊,而无需进行形肌肉切除术.
描述的方法产生了有利的临床结果,并避免了复发.

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