Anatomical study of joint capsule for hip arthroscopy innovation

2021 Fiscal Year Final Research Report

• Project/Area Number: 19K18488
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 56020:Orthopedics-related
• Research Institution: Morinomiya University of Medical Sciences (2021); Tokyo Medical and Dental University (2019-2020)
• Principal Investigator: Tsutsumi Masahiro 森ノ宮医療大学, インクルーシブ医科学研究所, 助教 (10821853)
• Project Period (FY): 2019-04-01 – 2022-03-31
• Keywords: 関節包 / 腸骨大腿靭帯 / 小殿筋 / 腸腰筋 / 輪帯 / 股関節鏡手術

Outline of Final Research Achievements

Hip arthroscopy is a minimally invasive and an innovative treatment, which enables early return to society. Because the diagnosis and treatment innovation corresponding to the arthroscopic technique is required, the hip stabilization mechanism should be also anatomically reconsidered for such innovation. Ligament has been considered as one of the joint stabilization mechanisms. On the other hands, "joint capsule", which cannot be anatomically separated from the ligament, has been considered as a thin sheet-like structure. We revealed that "joint capsule" has the following anatomical characteristics: 1) its attachment width was wider than previously reported, 2) it thickened by forming the complex with the pericapsular muscles' tendon and aponeurosis and its thickness distribution was not uniform, and 3) its shape changed with hip position, resulting in a bundle-like structure. We consider that the "joint capsule" contribution to the hip stabilization mechanism needs to be reconsidered.

Free Research Field

解剖学

Academic Significance and Societal Importance of the Research Achievements

①関節包は下前腸骨棘下方に幅広く付着し、その付着構造は機械的ストレスに順応し、腸骨大腿靭帯の近位付着部そのものであると考えられた。股関節鏡手術の関節包付着部を剥離する過程で、その外科的剥離が下前腸骨棘下方に及ぶと術後の関節不安定性の一因になりうることがわかった。②小殿筋腱・腸腰筋深層腱膜との結合により厚みを成した関節包そのものが、腸骨大腿靭帯実質部であると考えられた。腸骨大腿靭帯が、筋張力による影響を受け、関節運動に合わせながら“動的”に関節を支持しうることを明らかにした。③股関節伸展に伴う関節包の内腔への突出がいわゆる輪帯であり、関節包は肢位によって安定性への寄与が変化することがわかった。