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【科普】手术：从膝盖到屁股 Surgeons Move From Knees to Hips

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Surgeons Move From Knees to Hips

http://www.washingtonpost.com/wp-dyn/content/article/2009/04/27/AR2009042702605.html

By Sarah Halzack
Washington Post Staff Writer
Tuesday, April 28, 2009

Since the 1980s, arthroscopic surgery has been a common solution for people suffering pain in the knee or shoulder, providing a minimally invasive way to repair such injuries as torn ACLs and rotator cuffs. But those experiencing hip pain or stiffness have had more-limited options.

"Most people, especially athletes, when they had hip symptoms, usually they just got diagnosed as a chronic groin pull," said J.W. Thomas Byrd, a Nashville orthopedist who specializes in sports medicine and hip injuries. Rest and physical therapy might be prescribed, but no other solutions were available. Byrd also noted that because it's difficult to get standard surgical instruments into the hip safely, it has been "a bit more of a challenging joint to tackle" than the knee or shoulder.

But that's changing. In the past 10 to 15 years, doctors have discovered one specific cause of hip pain: a tear in the acetabular labrum, a condition in which the cartilage that lines the hip socket is damaged. And they've found that it can be fixed using arthroscopic surgery, which uses narrow instruments inserted through smaller incisions than traditional surgery.

New York Yankees star Alex Rodriguez recently made headlines when he opted to have arthroscopy on such a tear in his right hip, a decision that has him sidelined from baseball for weeks.

Derek Ochiai, a surgeon with the Nirschl Orthopaedic Center in Arlington, who began performing hip arthroscopy six years ago, estimates that he did only about a dozen of the procedures that year. Now, he performs more than 100 annually.

Ochiai also occasionally serves as an instructor at the Orthopaedic Learning Center, a surgeon's training lab in Rosemont, Ill., where he said three sessions are offered each year in hip arthroscopy and all are booked solid. This is a marked uptick from a decade ago, when Ochiai said the single course in hip arthroscopy was nearly canceled due to lack of interest.

The labrum is a thin ring of cartilage that lines the acetabulum, or hip socket. It acts as a cushion when the leg bends and provides stability to the joint. Left untreated, labrum tears can lead to arthritis. So, indirectly, "hip arthroscopy may be a way of delaying or even possibly preventing hip arthritis," Ochiai said.

These tears are not detectable by X-ray, and though they usually can be seen by MRI, even those images can sometimes be inconclusive. Ochiai said many patients see three or four orthopedists before getting a proper diagnosis.

There are several causes for labrum tears, but rigorous physical activity or stress is almost always a factor. Also, doctors often find some structural flaw in the hip joint, most commonly femoral acetabular impingement, known as FAI. This means that a bone deformity causes the ball and socket to rub against each other in a way that pinches the labrum. Doctors say FAI is not something a patient is born with; rather, it develops in adolescence, for unknown reasons. Byrd said it is more common in men than in women.

During arthroscopic surgeries on the labrum, doctors can fix the FAI by shaving down the bony defect.

Recovery time varies. When minimal work is done, it can be four to six weeks; when FAI is corrected, it can be more like three to four months.

Why has it taken so long for hip arthroscopy to catch up to its shoulder and knee counterparts?

"The big difference is that with the knee, most of the things we're doing arthroscopically evolved from things we were doing in open surgery," Byrd said. With the hip, however, doctors using arthroscopes discovered a host of conditions, including labrum tears and FAI, that had not been recognized. As a result, surgeons are trying to find remedies for problems that, Byrd said, had received "no treatment at all" in the past.

Plus, surgical techniques have improved. Byrd said that five to 10 years ago, the focus was on "cleaning it up," meaning taking out problem-causing bits of cartilage. While that is still done, restorative techniques have been introduced that allow for the preservation of the labrum instead of its removal.

Comments: halzacks@washpost.com.

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2009-04-28 13:26 浏览 : 649 回复 : 6

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2009-04-28 13:36

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Since the 1980s, arthroscopic surgery has been a common solution for people suffering pain in the knee or shoulder, providing a minimally invasive way to repair such injuries as torn ACLs and rotator cuffs. But those experiencing hip pain or stiffness have had more-limited options.
20世纪80年代以来，关节镜手术已成为解决患有膝关节或肩膀人的疼痛的常见办法，提供了一个微创的方式来修复如破坏的ACLs和肩袖之内的损伤。但是对于一些经历髋关节疼痛或僵硬患者关节镜的使用有更多的限制。

"Most people, especially athletes, when they had hip symptoms, usually they just got diagnosed as a chronic groin pull," said J.W. Thomas Byrd, a Nashville orthopedist who specializes in sports medicine and hip injuries. Rest and physical therapy might be prescribed, but no other solutions were available. Byrd also noted that because it's difficult to get standard surgical instruments into the hip safely, it has been "a bit more of a challenging joint to tackle" than the knee or shoulder.
“很多人，尤其是与动员，当他们有髋关节症状时候，他们通常会被诊断成慢性腹股沟牵拉伤，” J.W. Thomas Byrd这样说，他是纳什维尔的一名擅长于运动医学和髋关节损伤整形外科医生。Byrd还提到“可能会给予休息和理疗等处置方法，但没有其他的可利用的解决办法。” 因为它很难得到进入髋安全的标准手术器械，这相对膝关节或肩关节一直是个“处理起来比较有挑战性的关节”。

But that's changing. In the past 10 to 15 years, doctors have discovered one specific cause of hip pain: a tear in the acetabular labrum, a condition in which the cartilage that lines the hip socket is damaged. And they've found that it can be fixed using arthroscopic surgery, which uses narrow instruments inserted through smaller incisions than traditional surgery.
但，这一切正在发生变化，在过去的10-15年内，医生们发现髋臼唇破损是髋关节疼痛的明确的病因，即髋臼周围软骨破坏的一种状态。并且他们发现可以通过关节镜手术进行修补，相对于传统手术，关节镜手术通过更小的切口使用精密器械来操作。

New York Yankees star Alex Rodriguez recently made headlines when he opted to have arthroscopy on such a tear in his right hip, a decision that has him sidelined from baseball for weeks.
纽约明星Alex Rodriguez最近因对其有髋关节行关节镜手术而成为了头条新闻，这个决定使得他离开棒球场若干周。

Derek Ochiai, a surgeon with the Nirschl Orthopaedic Center in Arlington, who began performing hip arthroscopy six years ago, estimates that he did only about a dozen of the procedures that year. Now, he performs more than 100 annually.
Derek Ochiai，作为位于阿林顿的Nirschl整形外科中心的一名外科医生，6年前已经开始开展关节镜手术，6年前估计他一年内只做了12例患者，而现在，他每年要做超过100例这样的手术。

Ochiai also occasionally serves as an instructor at the Orthopaedic Learning Center, a surgeon's training lab in Rosemont, Ill., where he said three sessions are offered each year in hip arthroscopy and all are booked solid. This is a marked uptick from a decade ago, when Ochiai said the single course in hip arthroscopy was nearly canceled due to lack of interest.
Ochiai偶尔也会在整形外科学习中心做教师，中心是一个位于罗斯蒙特外科医生的培训实验室，在那儿他说每年提供三期的关节镜培训基本也是人满为患。这相对十年前来说，是一个显著的提升，Ochiai说当时每年仅一期的关节镜培训也会因为缺少有兴趣的学员而被取消。

The labrum is a thin ring of cartilage that lines the acetabulum, or hip socket. It acts as a cushion when the leg bends and provides stability to the joint. Left untreated, labrum tears can lead to arthritis. So, indirectly, "hip arthroscopy may be a way of delaying or even possibly preventing hip arthritis," Ochiai said.
在髋臼周围的软骨中，上唇是薄弱环节。在大腿弯曲的时候保证了关节的稳定性，上唇损伤如果没有治疗可能发展成关节炎。因此Ochiai间接的说“髋关节镜是可以延缓甚至避免髋关节炎的一种途径。”

These tears are not detectable by X-ray, and though they usually can be seen by MRI, even those images can sometimes be inconclusive. Ochiai said many patients see three or four orthopedists before getting a proper diagnosis.
这些损伤不能被X线察觉到，尽管在MRI上可见，但这些图像有时候也并非决定性的。Ochiai称许多病人通常看过3-4个整形科的医师后才能得到正确的诊断。

There are several causes for labrum tears, but rigorous physical activity or stress is almost always a factor. Also, doctors often find some structural flaw in the hip joint, most commonly femoral acetabular impingement, known as FAI. This means that a bone deformity causes the ball and socket to rub against each other in a way that pinches the labrum. Doctors say FAI is not something a patient is born with; rather, it develops in adolescence, for unknown reasons. Byrd said it is more common in men than in women.
关节唇损伤有许多原因，但是高强度的体力活动和压力几乎总是一个因素，并且，医生们通常可以发现髋关节的一些结构缺陷，最常见的是股骨头髋臼撞击,这就意味着，骨性畸形引起球窝结构相互摩擦挤压关节唇，医生们认为股骨头髋臼撞击并不是生来就有的一种病，而是在青春期由于未知的原因引起的，这种疾病男性比女性更为多见。

During arthroscopic surgeries on the labrum, doctors can fix the FAI by shaving down the bony defect.
在对关节唇实行关节镜手术的时候，医生们可以通过刮除骨性缺陷来修复股骨头髋臼撞击。

Recovery time varies. When minimal work is done, it can be four to six weeks; when FAI is corrected, it can be more like three to four months.
康复时间不一而论，当手术范围小时，一般需要4-6周来康复；当股骨头髋臼撞击修复时，则需要3-4个月来康复。
Why has it taken so long for hip arthroscopy to catch up to its shoulder and knee counterparts?
为什么髋关节的关节镜手术需要花费更多的时间来赶上肩关节和膝关节的关节镜手术的发展呢？
"The big difference is that with the knee, most of the things we're doing arthroscopically evolved from things we were doing in open surgery," Byrd said. With the hip, however, doctors using arthroscopes discovered a host of conditions, including labrum tears and FAI, that had not been recognized. As a result, surgeons are trying to find remedies for problems that, Byrd said, had received "no treatment at all" in the past.
“大不相同的是，对于膝关节，大部分我们所做的与关节镜手术相关的知识来至于开放手术的经验，” Byrd说，“但是对于髋关节，医生们在进行关节镜手术时候发现了许多包括关节唇损伤和FAI之类的许多状况，这些都是以前没有被认识的，因此手术医生正在对这些问题尝试治疗方法，而这些治疗方法在过去是没有的。”

Plus, surgical techniques have improved. Byrd said that five to 10 years ago, the focus was on "cleaning it up," meaning taking out problem-causing bits of cartilage. While that is still done, restorative techniques have been introduced that allow for the preservation of the labrum instead of its removal.
而且，随着外科技术的改善，Byrd说，5-10年之前，焦点在于“清除干净，”，意为，取出问题来源的软骨片，虽然现在仍然是这样，但恢复技术已被引入，可用于保存关节唇唇不是予以祛除。

2009-04-30 12:26

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2009-04-30 12:28

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