Artroscopia cadera
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Transcript of Artroscopia cadera
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ARTROSCOPIA CADERA
Drs. Eva EstanyRaul Puig AdellPau Golano
SECOT 2003
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1918 Takagi 1ª rodilla1931 Burman cadera cadaver1939 Takagi septica y charcot
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... pasaron los años hasta...
1971 Gross displasia cadera1983 Parisien portal anterior1986 Erikson traccion 25-50 kg1986 Jonhson tecnica y portales1986 Glick posicion lateral1988 Dorfman sin traccion
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Hip ArthroscopyRichard N. VillarB.H. 1992
Operative Hip ArtrhoscopyJ.W: Thomas ByrdEd. Thieme 1998
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INSTRUMENTAL
• Optica 4.5 mm 30º 70º• Canulas largas intercambiables• Trocares perforados con Kirshners• Puente corto
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INSTRUMENTAL
• Terminales motor largos• Canulas flexibles• Optica urologos
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ARTROSCOPIA CADERA
Anestesia generalMesa ortopédica
Intensificador imágenes• Torre artroscopia • lado contrario
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SIN TRACCIONDorfmann. Arthroscopy 1988
• No mesa traccion ni Rx • Flexion y rotacion cadera
Zona superficial -- SI• cuello• sinovial recesos• 2/3 cabeza femoral• labrum
Zona profunda – NO• acetabulo • 1/3 cabeza
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“ A simple approach to hip artrhroscopy “H.Dorfmann, Th Boyer, P. Henry, and B. De Bie. Arthroscopy 19881983-1988 60 artroscopia cadera
15 coxartrosis9 coxitis4 sinovitis vellonodular pigm.3 ruptura aislada labrum4 miscelanea10 normales15 condromatosis13 exeresis artroscopica
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CON TRACCION
• Traccion 25- 50 kg• Menos 2 horas
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TECNICA QUIRURGICA CON TRACCION
• Trocanter• Tangente borde superior trocanter• Linea espina anterosuperior
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TECNICA QUIRURGICA
• Aguja en el portal determina ángulo optimo y elimina presion negativa
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TECNICA QUIRURGICA
• Solo incidir piel ( Ferkel 1993 )• Canulas intercambiables ( Zarins 1993 )
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PORTALES ARTROSCOPICOS
AnteriorAnterolateralPosterolateral
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PORTAL ANTEROLATERAL
• Anterior margen trocanter• Trayecto gluteo medio• N. Gluteo superior 4,4 mm.
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PORTAL ANTEROLATERAL
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PORTAL ANTERIOR
Interseccion linea espina anterosuperior-tangente punta trocanter
Direccion 45º craneal 30º medial
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PORTAL ANTERIOR
Inspeccion desde portal anterolateralIntroducir aguja kirsners
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PORTAL ANTERIOR
• Trayecto sartorio recto anterior• N. femorocutaneo mm.• N. femoral 3,2 cm• Rama art. circunfleja 3.7mm
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PORTAL POSTEROLATERAL
Posterior margen trocanterTrayecto gluteo medio y menor anterior superior tendon piriformeN. ciatico 2,9 cm
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PORTAL POSTEROLATERAL
• Pie rotación neutra• Alejarnos n. ciatico
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PORTAL POSTEROLATERAL
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ANATOMIA ARTROSCOPICA
Cabeza femoral. Optica 70º 80%Acetabulo columna anterior-posterior
zona inferiorLigamento redondoSinovial fosa acetabularLabrumFovea Lig redondoCuello femoral (flexion sin tracción)
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INDICACIONES
diagnostica
biopsia
terapeutica
ayuda cirugia abierta
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INDICACIONES
Sinovitis reumaticaCondromatosis sinovialSinovitis vellonodular
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Condromatosis sinovial
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TRAUMATISMOS
• Roturas labrum• Ligamento redondo
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LESIONES LABRUM.
Etiologia clasificacion
Traumatica 55 % Fitzgerald18,9 % Lage
Degenerativa 48,65 % LageIdiopatica 45 % Fitzgerald
27,1% Lage
Congenita Subluxacion labrum Displasia fibrosa
Fitzgerald at al. Clin. Orthop 1995Lage at al. Arthroscopy 1996
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LESIONES LABRUMClasificacion morfologica
Flap radial 56,8%Fibrilacion radial 21,6%Lesion periferica long.16%Inestable 5,4%
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LIGAMENTO REDONDO
Fovea acetabular a fovea cabeza femoralSe tensa adduccionSe relaja abduccionFunciones: • estabiliza • protege arteria
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LIGAMENTO REDONDO
“The ligamentum theres of the hip. An arthroscopy classification of this pathology”Alistar al. Arthroscopy, vol.13 nº5. 1997.
ruptura completa post-luxacionruptura parcial post-fracturaruptura degenerativa
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TRAUMATISMOS
• Fracturas condrales• Fragmentos libres• Reduccion fracturas acetabulares
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Fracturas condrales
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Fragmentos libres
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• Desbridamiento artrosis• Luxación congenita cadera• Osteocondritis disecante
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• Enf. Perthes• Cemento cadera protesica• Necrosis avascular• Osteoma osteoide• Cadera septica
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CONTRAINDICACIONES
• Anquilosis• Osteofitosis artrosica• Calcificaciones perarticulares• Fibrosis cicatricial• Ostenecrosis estabilizadas• Infecciones superficiales
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COMPLICACIONESperine neuroapraxia n. ciatico y pudendolesion directa n. femorocutaneo mm
n. ciatico 2,9 mmnervio y art. femoral 3,2 mm
extravasación liquido cavidad abdominalcompresion
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COMPLICACIONES
lesion labrumlesion catilago articularruptura instrumentalnecrosis avascularosificaciones heterotopicasinfeccion