Results of a New Endoscopic Technique and Imaging Protocol
Rövid áttekintés:A pattanó csípőhöz vezethet belső, külső és intra-articularis elváltozás. Külső, a leggyakoribb ok, az iliotibialis szalag megakadása a trochanter majoron, amint a csipő flexióból extensióba mozdul. Intra articuláris ok lehet:labrum szakadás, szabad test, izületi porcból leváló darabka. Belső ok az iliopsoas ín proximális részének megakadása eminentia iliopectineaban, vagy átpattanása a femur fejen, amikor azt flexióból extensióba húzzuk. A belső és az intra-articuláris ok megkülönböztetése gyakran nehéz.
A kezdeti kezelés pihenésből, jegelésből, NSAID-ből, és nyújtásból áll. Lokálisan alkamazhatunk iontophoresist, és ultrahangot. A gyógyulás általában 6-8 hét. Esetlegesen az iliopsoas bursába adott injekció is segíthet. A makacs esetek kezelése több mint 3 hónap konzervatív terápia, ennek sikertelensége után, pedig az iliopsoas ín-izom komplexum hosszabítása, vagy release. Sajnos ezeknek a nyitott sebészi beavatkozásoknak magas a szövődményi aránya, amely leginkább a sebészi metszésvezetéssel kapcsolatos.
A cikk a szerzők vizsgálati protokollját és release technikáját ismerteti.
Csípő Rtg, MRA (MR artrographia, anaestheticum-kontraszt anyag), ha ezután nem csökkennek csípő fájdalmai akkor statikus és dinamikus UH (flexio-abdukció-kirotáció->extensio-berotáció-addukció), Color Doppler, majd UH vezérelte bursa anaestheticum injekció.
45 betegből végül 6-nál csípőartroszkópia 6-nál ezért endoscopos releaset végeztek.
A release előtt minden beteg csipő artroszkópián esett át. Az artroszkópia után az extensiót megszüntették és térdet 30° -ban flektálták, a csípőt kirotálták. Két portál közül az egyiket a kis trochanter közepe szintjében a femurra merőlegesen, a másik 5 cm-rel distalisabban alakították ki. Az iliopsoas szalagot electro-kauterrel leválasztották a tapadásáról. A műveletet képerősítővel is ellenőrizték, mert a tapadástól 2-3cm-re proximálisan futnak a mediális és laterális circumflexa artériák.
Összességében az endoscopos technika előnye a nyílt műtétekhez képest, hogy egyidejűleg csípő izület artroszkópia is végezhető (esetleges labrum sérülés ellátása), egynapos sebészet keretében kivitelezhető, mentes a nyílt műtétekre jellemző szövődményektől, és a panaszokat hatásosan csökkenti.
A kezdeti kezelés pihenésből, jegelésből, NSAID-ből, és nyújtásból áll. Lokálisan alkamazhatunk iontophoresist, és ultrahangot. A gyógyulás általában 6-8 hét. Esetlegesen az iliopsoas bursába adott injekció is segíthet. A makacs esetek kezelése több mint 3 hónap konzervatív terápia, ennek sikertelensége után, pedig az iliopsoas ín-izom komplexum hosszabítása, vagy release. Sajnos ezeknek a nyitott sebészi beavatkozásoknak magas a szövődményi aránya, amely leginkább a sebészi metszésvezetéssel kapcsolatos.
A cikk a szerzők vizsgálati protokollját és release technikáját ismerteti.
Csípő Rtg, MRA (MR artrographia, anaestheticum-kontraszt anyag), ha ezután nem csökkennek csípő fájdalmai akkor statikus és dinamikus UH (flexio-abdukció-kirotáció->extensio-berotáció-addukció), Color Doppler, majd UH vezérelte bursa anaestheticum injekció.
45 betegből végül 6-nál csípőartroszkópia 6-nál ezért endoscopos releaset végeztek.
A release előtt minden beteg csipő artroszkópián esett át. Az artroszkópia után az extensiót megszüntették és térdet 30° -ban flektálták, a csípőt kirotálták. Két portál közül az egyiket a kis trochanter közepe szintjében a femurra merőlegesen, a másik 5 cm-rel distalisabban alakították ki. Az iliopsoas szalagot electro-kauterrel leválasztották a tapadásáról. A műveletet képerősítővel is ellenőrizték, mert a tapadástól 2-3cm-re proximálisan futnak a mediális és laterális circumflexa artériák.
Összességében az endoscopos technika előnye a nyílt műtétekhez képest, hogy egyidejűleg csípő izület artroszkópia is végezhető (esetleges labrum sérülés ellátása), egynapos sebészet keretében kivitelezhető, mentes a nyílt műtétekre jellemző szövődményektől, és a panaszokat hatásosan csökkenti.
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Köszönöm, remélem nem lesz rá szükség. :)
Kicsit érzem még, most épp nem sportolok semmit. Ha jövő hétig nem javul (kenem is), elnézek egy orvoshoz.
Ha sebészre lesz szükségem remélem megkereshetlek. :)
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