Abstract:
Background Currently, there is a lack of methods to accurately determine the direction of puncture when establishing the hip arthroscopy portals.
Objective To propose a method for assisting in determination of the direction of puncture for anterolateral (AL) and modified anterior (MA) portals for hip arthroscopy, and verify its feasibility and accuracy.
Methods Patients who were proposed to undergo hip arthroscopy in our department from January 2021 to June 2022 were recruited prospectively. Intraoperatively, a solid steel ball was used under fluoroscopy to locate the acetabular sourcil midpoint body marker (SMBM), and a point 5 mm caudal to the SMBM was used as the puncture location point for establishing portals. When establishing the AL and MA portals, the puncture was performed in the direction of the puncture location point, and this method was called the acetabular sourcil midpoint calibration. The accuracy of the puncture into the joint space was calculated. The horizontal distance (X) and vertical distance (Y) between the SMBM and the inferior edge of the anterior superior iliac spine (ASIS) were measured intraoperatively, and the dispersion of these distances was analyzed. Multiple linear regression was used to analyze the correlation of the horizontal (X) and vertical (Y) distances in relation to the patient's general information and the imaging parameters of anteroposterior pelvis radiograph.
Results A total of 53 hip arthroscopy cases were recruited, including 34 males and 19 females, with average age of 34.91 ± 12.26 years. Twenty-five cases were on the left side and 28 cases were on the right side. The puncture accuracy rate was 94.3% for the establishment of the AL portal and 90.6% for the establishment of the MA portal. The horizontal distance (X) was 2.94 ± 1.07 cm (95% CI: 0.80-4.79 cm), following a normal distribution; the vertical distance (Y) was 1.64 ± 1.02 cm (95% CI: 0.00-3.76 cm), following a normal distribution. The horizontal (X) and vertical (Y) distances were not significantly correlated with the patients' general information and the imaging parameters of anteroposterior pelvis radiograph (P > 0.05).
Conclusion While establishing the AL and MA portals, the acetabular sourcil midpoint calibration can locate the exact puncture direction. The location of the SMBM can be initially determined by the mean and 95% confidence interval of the horizontal distance (X) and vertical distance (Y) before establishing portals.
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