髋关节镜的未来

The Future of Hip Arthroscopy

髋关节镜的未来

Joseph C. McCarthy, Philip C. Noble, and Richard N. Villar

约瑟夫·麦卡锡、菲利普·诺布尔和理查德·维拉

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Over the past 30 years, indications for hip arthroscopy have grown remarkably to nearly 30 procedures, each of these vet-ted in this textbook.Minimally invasive arthroscopic proce-dures are one of the fastest growing areas of orthopedics, witnessed by the exponentially increasing numbers of publications in the literature as well as the founding of orga-nizations such as ISHA (The International Society of Hip Arthroscopy).And yet the rapid advancements in this area have served to highlight significant limitations in our knowl-edge of the hip joint.These limitations serve to spawn further investigation of the hip itself, and continuing efforts to address pathologic conditions in and around this complex joint.

在过去的30年里，髋关节镜检查的适应症已经显著增加到了近30种，每一种都在这本教科书中进行了讨论。微创关节镜手术是骨科发展最快的领域之一，文献中出版物的数量呈指数级增长，以及ISHA(国际髋关节镜学会)等组织的成立都证明了这一点。然而，这一领域的快速发展凸显了我们髋关节知识的巨大局限性。这些局限性促使人们对髋关节本身进行进一步的研究，并继续努力解决这个复杂关节内和周围的病理状况。

Future developments in hip surgery will be multifaceted in nature and will be expedited by advances in technology, bioma-terials, and analysis of outcomes.Essential to this evolutionary process will be advances in radiologic imaging, particularly visualizing dynamic joint motion and allowing functional patho-analysis.This will allow much better understanding of genetic, traumatic, and pathologic hip morphologic rmation from this imaging will greatly improve the treating surgeon's capability to determine precise surgical indi-cations, planning, as well as facilitate accurate execution of the surgery.Surgical techniques will also further improve as a

髋关节外科的未来发展将是多方面的，并将因技术、生物材料和结果分析的进步而加速。对这一进化过程至关重要的是放射学成像的进步，特别是动态关节运动的可视化和功能病理分析。这将有助于更好地理解遗传性、创伤性和病理性髋关节形态学异常。来自该成像的信息将极大地提高治疗外科医生确定精确的手术指示、计划以及促进手术精确实施的能力。外科技术也将进一步提高

byproduct of the next generation of dedicated surgical tables, more sophisticated procedural instruments as well as improve-ments in the visualization of arthroscopic pathology.Better education and imaging will also facilitate screening of infants and adolescents for early diagnosis of hip pathology and greater emphasis on preventive care.

下一代专用手术台的副产品，更复杂的手术器械以及关节镜病理可视化的改进。更好的教育和成像还将有助于婴儿和青少年的筛查，以便对髋关节病变进行早期诊断，并更加重视预防性护理。

Hip arthroscopy will continue to evolve with techniques to resect and repair diseased tissue, and procedures that pro-vide options for joint reconstruction and regeneration, par-ticularly in treating cartilage lesions.Essential to these advancements will be the development of implants to address focal defects—both prosthetic as well as biologic, for restor-ing cartilage in areas of extensive

injury or wear.The bio-logic arsenal for implantation is yet to be determined, but will include, among others, MACI (matrix autologous carti-lage implantation), MSCs (mesenchymal stem cells), PRP (platelet-rich plasma) derivatives, adhesives, and hyaluro-nate lubrication materials.A requisite to accurately plan and execute these intricate joint reconstructions will be surgical navigation and robotics.

髋关节镜检查将随着切除和修复病变组织的技术以及为关节重建和再生，特别是治疗软骨损

伤提供选择的程序而继续发展。对这些进步至关重要的是发展植入物来解决局部缺陷——修

复性的和生物性的，用于在大面积损伤或磨损的区域恢复软骨。植入的生物逻辑库尚未确定，但将包括MACI(基质自体软骨植入)、间充质干细胞(间充质干细胞)、PRP(富含血小板的血浆)衍生物、粘合剂和透明质酸盐润滑材料。精确计划和执行这些复杂的关节重建的必要条

件是外科导航和机器人技术。

To perform advanced intra-articular and periarticular pro-cedures, surgeons will require comprehensive educational and surgical training, facilitated by organizations such as AAOS, AANA, AAHKS, AOSSM, ISHA, and other interna

为了进行高级关节内和关节周围的手术，外科医生将需要全面的教育和外科培训，由AAOS、AANA、AAHKS、奥斯姆、ISHA和其他国际组织提供便利

J.C. McCarthy, MD (*)

医学博士麦卡锡(*)

Kaplan Joint Center, Newton-Wellesley Hospital, 2000 Washington Street, Suite 361, Green Building, Newton, MA 02462, USA

美国马萨诸塞州牛顿市格林大厦361室华盛顿街2000号牛顿-韦尔斯利医院卡普兰联合中心

e-mail: JCMCCARTHY1@

电子邮件:JCMCCARTHY1@

P.C. Noble, PhD

诺贝尔博士

Director of Research, Institute of Orthopedic Research and Education, 6550 Fannin Street, Suite 2501, Houston, TX 77030, USA

美国德克萨斯州休斯顿范宁街6550号，邮编77030，2501室，矫形研究和教育学院研究部

主任

e-mail: pnoble@

电子邮件:pnoble@