The layer concept: Utilization in determining the pain generators, pathology and how structure determines treatment

被引:46
作者
Draovitch P. [1 ]
Edelstein J. [1 ]
Kelly B.T. [2 ]
机构
[1] Hospital for Special Surgery, New York, NY 10021
[2] Hospital for Special Surgery, Center for Hip Preservation, New York, NY 10021
关键词
Bony pathology; Capsular laxity; Femoroacetabular impingement; Hip arthroscopy; Neuromuscular control;
D O I
10.1007/s12178-011-9105-8
中图分类号
学科分类号
摘要
The level of understanding of pain in the non-arthritic hip has made significant strides in the last couple of decades beginning with the discoveries of Reinhold Ganz, MD. However, even with the detection of subtle bony abnormalities, including femoroacetabular impingement, a clinician's ability to differentiate pain generators in the hip has been ambiguous. Deciphering the etiology of the pathology versus the pain generator is essential in prescribing the proper treatment. The Layer Concept developed by Dr. Bryan Kelly, is a systematic means of determining which structures about the hip are the source of the pathology, which are the pain generators and how to then best implement treatment. Four layers will be discussed in this article. Layer I, the osseous layer, Layer II, the inert tissue layer, Layer III, the contractile layer and Layer IV, the neuromechanical layer. © 2012 Springer Science+Business Media, LLC.
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页码:1 / 8
页数:7
相关论文
共 66 条
[1]  
Jones R., Cheilectomy of head of femur in house painter, British Orthopedic Association Symposium on Treatment of Osteoarthritis of the Hip, 1920
[2]  
Smith-Petersen M.N., Treatment of malum coxae, senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxa plana by means of acetabuloplasty, J Bone Joint Surg Am, 18, pp. 869-880, (1936)
[3]  
Heyman C.H., Treatment of slipping of the upper femoral epiphysis, Surg Gynecol Obstet, 89, pp. 559-565, (1949)
[4]  
Murray R.O., The aetiology of primary osteoarthritis of the hip, Brit J Radiol, 38, pp. 810-824, (1965)
[5]  
Stulberg S.D., Harris W.H., Acetabular dysplasia and development of osteoarthritis of the hip, Proceedings of the Second Open Scientific Meeting of the Hip Society, St. Louis, (1974)
[6]  
Solomon L., Patterns of osteoarthritis of the hip, J Bone Joint Surg Br, 58 B, pp. 176-183, (1976)
[7]  
Ganz R., Parvizi J., Beck M., Et al., Femoroacetabular Impingement: A cause for osteoarthritis for the hip, Clin Orthop Relat Res, 417, pp. 111-119, (2003)
[8]  
Ganz R., Leunig M., Leunig-Ganz K., Harris W.H., The etiology of osteoarthritis of the hip: An integrated mechanical concept, Clinical Orthopaedics and Related Research, 466, 2, pp. 264-272, (2008)
[9]  
Patel K., Wallace R., Busconi B., Radiolology, Clin Sports Med, 30, pp. 239-283, (2011)
[10]  
Bittersohl B., Hosalker H., Apprich S., Et al., Comparison of preoperative dGEMRIC imaging with intra-operative findings in femoroacetabular impingement: Preliminary findings, Skeletal Radiol, 40, pp. 553-561, (2011)