髋关节镜手术相关髋关节粘连的预防和治疗效果良好

IF 4.4 1区 医学 Q1 ORTHOPEDICS
Christopher L McCrum
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引用次数: 0

摘要

众所周知,关节镜手术和多关节开放手术(包括髋关节镜手术)后都会发生粘连,导致疼痛、僵硬和功能障碍。髋臼唇与上覆髋关节囊的粘连会导致髋臼唇外翻,并有可能破坏吸力密封,从而导致微不稳定和疼痛。一般来说,无论是否同时矫正唇囊、软骨或骨质病变,手术溶解粘连后患者的治疗效果都会有所改善。如果髋臼唇和髋臼囊之间的粘连阻碍了充分的吸入密封,关节镜下放置自体或异体移植物垫片可能会有效。使用血管紧张素 II 受体阻滞剂(如洛沙坦)等生物制剂进行预防,可抑制 TGF-β1(转化生长因子β1),而 TGF-β1与纤维化、组织纤维化和瘢痕形成有关。洛沙坦的副作用很少见,但包括低血压、头晕、血管性水肿,以及与非甾体抗炎药合用时的急性肾损伤。在更广泛地采用洛沙坦之前,需要更多关于洛沙坦使用情况的数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Editorial Commentary: Prevention and Treatment of Hip Adhesions Associated With Hip Arthroscopy Shows Positive Outcomes.

Adhesions are known to occur following arthroscopic as well as open surgery of multiple joints, including after hip arthroscopy, resulting in pain, stiffness, and dysfunction. Adhesions of the labrum to the overlying hip capsule can lead to eversion of the labrum and potentially compromise the suction seal, leading to microinstability and pain. Generally, patient-reported outcomes improve after surgical lysis of adhesions, with or without concurrent correction of labral, chondral, or bony pathology. Arthroscopic placement of autograft or allograft spacers may be effective when adhesions between the labrum and capsule prevent an adequate suction seal. Prevention using biologics, such as angiotensin II receptor blockers (e.g., losartan), may inhibit transforming growth factor β1, which has been associated with fibrogenesis, tissue fibrosis, and scarring. Side effects of losartan are rare but include hypotension, dizziness, angioedema, and acute kidney injury when coprescribed with nonsteroidal anti-inflammatory drugs, which are often used in heterotopic ossification prophylaxis in hip arthroscopy and are a significant concern. More data on losartan use are required prior to broader adoption.

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来源期刊
CiteScore
9.30
自引率
17.00%
发文量
555
审稿时长
58 days
期刊介绍: Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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