ABSTRACT
To describe the arthroscopic surgical technique for subspine impingement (SSI) of the anterior inferior iliac spine (AIIS) associated with mixed type femoroacetabular impingement (FAI), through two standard arthroscopic portals (anterolateral and distal mid-anterior) in two patients with trifocal impingement. The authors report the cases of two young male patients, aged 32 and 36 years old, with trifocal femoropelvic impingement (TFPI). The technique consists of segmental capsulectomy, arthroscopic dissection of the AIIS, partial release of the direct head of the rectus femoris, resection of the AIIS projection with a burr and with fluoroscopic aid, correction of the pincer deformity, repair of the labrum with bioabsorbable anchors, and femoral osteoplasty. Details of the diagnostic workup and of the surgical technique are provided and discussed. In these cases, full range of motion was regained after surgery, as well as complete relief of pain, which was sustained in the last follow-up, one year post-operatively. Radiographs show adequate correction of the deformities in all three impingement sites. Simultaneous correction of the three sites (cam, pincer, and subspinal) provided full relief of symptoms and allowed return to work and sports. The authors propose that when approaching the symptomatic SSI, the possibility of concomitant FAI should always be considered and, in those cases, the approach must be comprehensive.
O objetivo deste trabalho foi descrever a abordagem cirúrgica artroscópica do impacto subespinhal (ISE) da espinha ilíaca anteroinferior (EIAI) associado ao impacto femoroacetabular (IFA) misto, por meio de dois portais artroscópicos padrão (anterolateral e medioanterior distal) em pacientes com impacto trifocal. Os autores relatam os casos de dois pacientes do sexo masculino, de 32 e 36 anos, com impacto femoropelvico trifocal (IFPT). A técnica consiste na ressecção segmentar da cápsula, dissecção artroscópica da EIAI com liberação parcial do reto femoral, osteoplastia com ressecção da proeminência com lâmina óssea e auxílio radioscópico, correção do pincer, reparo da lesão condrolabial com âncoras e osteoplastia femoral. Detalhes sobre o diagnóstico e a técnica são apresentados e discutidos. Nos casos operados, foi observada recuperação do arco de movimento normal do quadril e ausência de dor, que se mantiveram por um ano pós-operatório. Radiografias demonstram boa correção dos três focos de impacto em ambos os pacientes. A simultânea correção do IFPT nos seus três componentes (came, pincer e subespinhal) promoveu alívio completo dos sintomas e o retorno ao trabalho e aos esportes. Propõe-se que, na abordagem do ISE sintomático, sempre seja considerada a possibilidade da presença de IFA associado; nesses casos, a abordagem deve ser completa.
ABSTRACT
ABSTRACT To describe the arthroscopic surgical technique for subspine impingement (SSI) of the anterior inferior iliac spine (AIIS) associated with mixed type femoroacetabular impingement (FAI), through two standard arthroscopic portals (anterolateral and distal mid-anterior) in two patients with trifocal impingement. The authors report the cases of two young male patients, aged 32 and 36 years old, with trifocal femoropelvic impingement (TFPI). The technique consists of segmental capsulectomy, arthroscopic dissection of the AIIS, partial release of the direct head of the rectus femoris, resection of the AIIS projection with a burr and with fluoroscopic aid, correction of the pincer deformity, repair of the labrum with bioabsorbable anchors, and femoral osteoplasty. Details of the diagnostic workup and of the surgical technique are provided and discussed. In these cases, full range of motion was regained after surgery, as well as complete relief of pain, which was sustained in the last follow-up, one year post-operatively. Radiographs show adequate correction of the deformities in all three impingement sites. Simultaneous correction of the three sites (cam, pincer, and subspinal) provided full relief of symptoms and allowed return to work and sports. The authors propose that when approaching the symptomatic SSI, the possibility of concomitant FAI should always be considered and, in those cases, the approach must be comprehensive.
RESUMO O objetivo deste trabalho foi descrever a abordagem cirúrgica artroscópica do impacto subespinhal (ISE) da espinha ilíaca anteroinferior (EIAI) associado ao impacto femoroacetabular (IFA) misto, por meio de dois portais artroscópicos padrão (anterolateral e medioanterior distal) em pacientes com impacto trifocal. Os autores relatam os casos de dois pacientes do sexo masculino, de 32 e 36 anos, com impacto femoropelvico trifocal (IFPT). A técnica consiste na ressecção segmentar da cápsula, dissecção artroscópica da EIAI com liberação parcial do reto femoral, osteoplastia com ressecção da proeminência com lâmina óssea e auxílio radioscópico, correção do pincer, reparo da lesão condrolabial com âncoras e osteoplastia femoral. Detalhes sobre o diagnóstico e a técnica são apresentados e discutidos. Nos casos operados, foi observada recuperação do arco de movimento normal do quadril e ausência de dor, que se mantiveram por um ano pós-operatório. Radiografias demonstram boa correção dos três focos de impacto em ambos os pacientes. A simultânea correção do IFPT nos seus três componentes (came, pincer e subespinhal) promoveu alívio completo dos sintomas e o retorno ao trabalho e aos esportes. Propõe-se que, na abordagem do ISE sintomático, sempre seja considerada a possibilidade da presença de IFA associado; nesses casos, a abordagem deve ser completa.
Subject(s)
Humans , Male , Adult , Arthroscopy , Joint Deformities, Acquired , Hip Injuries , Femoracetabular Impingement , Hip JointABSTRACT
Considering the complex relationship between asthma symptoms and exercise, asthmatics are usually believed to be less active in daily life than healthy subjects. However, few studies have objectively assessed daily-life physical activity (DLPA) of asthmatic adults. OBJECTIVE: To objectively assess DLPA of a sample of Brazilian asthmatic women in comparison to healthy controls, and to investigate the associations between DLPA and asthma control, health-related quality of life, anxiety and depression levels, and the Six-minute walk test (6MWT) in this population. METHODS: Sixty-six women were included, 36 in the asthma group (AG) and 30 in the control group (CG). The AG was composed by clinically stable moderate-to-severe asthmatics. The CG was composed by apparently healthy volunteers. All subjects underwent DLPA assessment (considered as the average of steps taken during six consecutive days measured by a pedometer) and performed the 6MWT. Additionally, participants in the AG were assessed using the Asthma Control Questionnaire, the Asthma Quality of Life Questionnaire (AQLQ), and the Hospital Anxiety and Depression Scale. RESULTS: There was no difference between the AG and the CG regarding DLPA (7490.3 ± 3330.2 vs 6876.4 ± 3242.1 steps respectively, p = 0.45), even after adjustment for covariates. DLPA was significantly correlated to the activity limitation domain of the AQLQ among asthmatics (r = 0.43, p < 0.01). CONCLUSION: Despite the association between self-perceived activity limitation and DLPA among asthmatics, there were no differences regarding DLPA between a sample of moderate-to-severe Brazilian asthmatic women and apparently healthy controls.
