Schuh A, Zeiler G
Orthopädische Klinik Rummelsberg, Schwarzenbruck.
Zentralbl Chir. 2003 Feb;128(2):139-2; discussion 143. doi: 10.1055/s-2003-37768.
Rupture of the gluteus medius tendon is a rare, even neglected condition. Typical findings include local tenderness and weakness of hip abduction. This pathologic condition is very seldom analysed in the literature, there is no report about the meaning in primary total hip replacement (THR).
Between 1/1/1995 and 12/31/2000 we found 13 cases (3,5 %) with a tear of the gluteus medius tendon in 372 primary THR using the lateral approach. In all cases the rupture was seen in the ventral and lateral part of the gluteus medius tendon. Furthermore, a valgus position of the proximal femur was detected. Transosseous refixation of the tendons was performed in all cases. 3 months after operation local tenderness near the greater trochanter disappeared and full strength of the pelvitrochanteric muscles was achieved in 11 out of 13 cases and in the remaining cases after one year.
When a valgus position of the proximal femur in primary THR is found, one has to be aware of a simultaneous rupture of the gluteus medius tendon. This pathologic finding has to be ruled out preoperatively by means of ultrasound or MRI and an adequate approach to the hip joint has to be selected to examine the pelvitrochanteric muscles and to treat the rupture.
臀中肌腱断裂是一种罕见的、甚至被忽视的病症。典型表现包括局部压痛及髋关节外展无力。这种病理状况在文献中很少被分析，关于其在初次全髋关节置换术（THR）中的意义尚无报道。
在1995年1月1日至2000年12月31日期间，我们在372例采用外侧入路的初次THR中发现13例（3.5%）存在臀中肌腱撕裂。所有病例中，撕裂均见于臀中肌腱的腹侧和外侧部分。此外，还检测到股骨近端呈外翻位。所有病例均进行了肌腱的经骨重新固定。术后3个月，大转子附近的局部压痛消失，13例中有11例在术后11个月时骨盆转子肌恢复了全部力量，其余病例在1年后恢复。
在初次THR中发现股骨近端呈外翻位时，必须警惕同时存在的臀中肌腱断裂。术前必须通过超声或MRI排除这一病理发现，并选择合适的髋关节入路来检查骨盆转子肌并治疗断裂。
