Clinical Application Of Modified Anterior Approach Arthroscopic In The Treatment Of Hip Peripheral Compartment Lesions

Background And Objective The clinical application of hip arthroscopy began in the 1930s.With the popularization of MRI technology,the improvement of instruments,the progress of surgical technology and the deepening of the concept of minimally invasive,hip arthroscopy has entered a period of rapid development in the past 30 years.Originally it was used only to assist in the diagnosis of hip joint diseases,after gradually used in joint loose bodies removal,synovial cleaning and pathological biopsy,has been widely used in synovial labral tears,acetabular or femoral head cartilage lesions,synovial chondromatosis,femoroacetabular impingement,avascular necrosis of the femoral head,injure of ligamentum teres,diagnosis and treatment of acetabular dysplasia and other diseases.In addition to the use of hip arthroscopy to treat"snapping hip",iliopsoas bursitis and other joint cystic lesions have also achieved good clinical results.Under arthroscopy,the hip joint is divided into central compartment and peripheral compartment,and most hip joint lesions are confined to the peripheral compartment.The commonly used hip arthroscopy approach includes the anterior approach,the anterior lateral approach and the posterior lateral approach.The establishment of these approaches needs to be carried out under the traction and C-arm perspective,these complex operations are likely to prolong the operation time,lead to traction related complications,which limits the development of hip arthroscopy.It is necessary to explore a simpler and more effective way of hip arthroscopic surgery.Our study retrospectively analyzed the data of 81 patients who underwent hip arthroscopic surgery through modified anterior approach and conventional approach in the department of orthopaedics of the First affiliated hospital of Zhengzhou University from January 2013 to June 2018,to explore the clinical effect of modified anterior approach hip arthroscopy in the treatment of peripheral compartment lesions.Methods This study retrospectively analyzed the complete data of 81 patients who underwent hip arthroscopic surgery in the department of orthopaedics of the First affiliated hospital of Zhengzhou University from January 2013 to June 2018.The patients were divided into conventional group and modified group according to different surgical approach.30 patients in the conventional group,including 24 males and 6 females,underwent hip arthroscopic surgery through three conventional approach.In the modified group,51 patients（39 males and 12 females）underwent hip arthroscopic surgery through a modified anterior approach.During the operation,the time from the completion of towel laying to the establishment of the approach was recorded as the establishment time T₁,and the time from the completion of the establishment of the approach to the completion of the suture of the skin was the operation time T₂.VAS pain score and Harris hip function score were used for efficacy evaluation,and scores were given preoperatively,2 weeks postoperatively,3months postoperatively and 6 months postoperatively.SPSS 21.0 statistical software was used for data analysis,and One-way Anova was performed for general data such as age and course of patients in the two groups.Chi-square test were tested the disease types of the two groups.t-test was used to compare T₁,T₂,VAS score and Harris hip function score between the two groups.P<0.05 was considered statistically significant.Results 1.There were no significant differences in general data,preoperative VAS pain scores and preoperative Harris hip function scores between conventional group and modified groups（P>0.05）;2.The difference between the conventional group and the modified group was statistically significant（P<0.05）in the average time of establishment approach T1and the average operation time T2.The average time of establishment approach and the average operation time in the modified group were less than those in the conventional group;3.There was no significant difference in the VAS score and the Harris hip score at 2 weeks,3 months,and 6 months after surgery between the conventional group and the modified group（P>0.05）.The modified approach can achieve the same short-term clinical efficacy as the conventional approach;4.There were 2 cases of postoperative complications in the conventional group,including sciatic nerve injury and perineal soft tissue crush injury.In the improved group,1 case had postoperative complications and was the lateral femoral cutaneous nerve injury.Conclusions The modified anterior approach hip arthroscopy technique can achieve the same short-term clinical efficacy as conventional approach in the treatment of peripheral compartment lesions of the hip.The modified anterior approach hip arthroscopy technique can shorten the operation time and improving surgical efficiency.The modified anterior approach avoids the traction related complications,but there is still the risk of lateral femoral cutaneous nerve injury.