臀大肌肌腱移植作为治疗疼痛的慢性髋外展肌功能不全的挽救选择:临床和MRI结果,至少随访24个月。

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-03-01 Epub Date: 2023-09-05 DOI:10.1177/11207000231197760
Dominik Kaiser, Armando Hoch, Reto Sutter, Patrick O Zingg
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引用次数: 0

摘要

简介:慢性髋外展肌功能不全是一种罕见的使人衰弱的疾病。在保守治疗难治且不适合直接修复的情况下,有必要进行增强治疗。在我们机构,首选的挽救方法是用臀大肌前三分之一肌腱增强。本研究的目的是描述8名患者的结果,他们接受了痛苦的慢性髋外展肌功能不全伴臀大肌转移的治疗,经过24小时的最小随访 包括髋外展肌术前和术后的完整临床和MRI评估。方法:我们回顾性分析了连续8例因疼痛的慢性髋外展肌功能不全而接受手术治疗的患者。所有患者均出现Trendelenburg征,肌肉力量受损(M ⩽ 3) 以及髋外展肌完全撕脱,伴有明显的脂肪变性(⩾3)。在24小时的最小随访后,获得了疼痛程度、肌肉力量、功能评分以及术后MRI 月。结果:患者的平均年龄为69岁 年,平均随访35(26-54)个月。术后疼痛从VAS 5显著降低至VAS 2.5(p = 0.046)。所有患者的Trendelenburg征均为阳性,髋外展肌力量在2.4至3.1之间没有显著改善(p = 0.19)。在最后的随访中,所有患者的MRI都证实了转移肌腱的完全愈合。对髋外展肌力量和患者报告的功能结果评分的影响是有限的。尽管效果平平,但由于缺乏更好的替代方案,它仍然是我们首选的抢救治疗方案。需要进行更大规模的研究来证实这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Gluteus maximus tendon transfer as a salvage option for painful chronic hip abductor insufficiency: clinical and MRI results with a minimum follow-up of 24 months.

Introduction: Chronic hip abductor insufficiency is a rare debilitating condition. In cases refractory to conservative treatment and not amenable to direct repair an augmentation becomes necessary. The preferred salvage method at our institution is augmentation with the anterior third of the gluteus maximus tendon. The aim of this study is to describe the results of 8 patients, treated for painful chronic hip abductor insufficiency with gluteus maximus muscle transfer, after a minimal follow-up of 24 months including a full clinical and MRI evaluation of the hip abductors pre- and postoperatively.

Methods: We retrospectively reviewed a consecutive series of 8 patients who were surgically managed for painful chronic hip abductor insufficiency. All patients had a Trendelenburg sign, impaired muscle strength (M ⩽ 3) as well as a complete avulsion of the hip abductors with marked fatty degeneration (⩾3). Pain levels, muscle strength, functional scores as well as a postoperative MRI was obtained after a minimal follow-up of 24 months.

Results: The mean age of the patients was 69 years, mean follow-up was 35 (26-54) months. Pain was significantly reduced postoperatively to VAS 2.5 from VAS 5 (p= 0.046). Trendelenburg sign remained positive in all patients and hip abductor strength did not improve significantly from 2.4 to 3.1 (p= 0.19). Complete healing of the transferred tendon was confirmed by MRI in all patients at last follow-up.

Conclusions: In the setting of painful chronic hip abductor insufficiency refractory to conservative treatment with advanced muscle degeneration without the possibility of a direct reconstruction the gluteus maximus tendon transfer significantly decreased pain. The effect on hip abductor strength and patient-reported functional outcome scores is limited. Despite the modest results it remains our preferred salvage treatment option for lack of better alternatives. Larger studies are necessary to confirm these findings.

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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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