tailieunhanh - Operative Hip Arthroscopy - part 8

sử dụng các thiết bị ArthroCare (ArthroCare, Sunnyvale, CA) và Mitek VAPR (Ethicon, Someville, NJ) với thành công tốt. Bắt đầu từ bên trung gian của gân, nó IS làm việc sectioned chiều ngang (hình ). Cho dù để làm một phát hành một phần hoặc toàn dựa trên lâm sàng | CHAPTER 12 ARTHROSCOPIC ILIOPSOAS RELEASE FOR COXA SALTANS INTERNA 191 Psoas muscle Iliacus muscle FIGURE . The iliacus and psoas muscles form a conjoined tendon that inserts onto the lesser trochanter. POSTOPERATIVE TREATMENT used the ArthroCare devices ArthroCare Sunnyvale CA and the Mitek VAPR Ethicon Someville NJ with good success. Starting from the medial side of the tendon it is sectioned working laterally Figure . Whether to do a partial or complete release is based on clinical judgment. The goal is to lengthen the musculotendinous unit and a partial release accomplishes this. If there is pathology in the tendon such as a bifid or trifid appearance Figure or if the lesser trochanter has a spur a complete release is recommended. The portals are sutured and a thigh dressing is applied with compression. Crutches with partial weight bearing are used until the patient has good control of the hip usually 2 to 3 weeks . Flexion exercises are begun immediately and strength returns in 3 to 6 weeks after a partial release and 3 to 6 months after a com- FIGURE . The iliopsoas lies anterior to the hip capsule and moves lateral with hip flexion abduction and external rotation. As the hip is extended adducted and internally rotated the tendon moves in a medial direction. 192 THOMAS G. SAMPSON A FIGURE . A Fluoroscopic view with the C-arm giving an orthogonal view of the lesser trochanter while the hip is externally rotated and instruments are positioned. B The arthroscope is placed through the far anteroinferior portal and the cutting instrument through the anteroinferior portal. B FIGURE . A Arthroscopic view of the iliopsoas tendon inserting onto the lesser trochanter. B After partial release. FIGURE . A Patient in the lateral decubitus position the C-arm in place. The portals are posterolateral PL anterolateral AL anterior A anteroinferior AI and far anteroinferior FAI . B Technique using the FAI and the anteroinferior medial AIM .