Blankenbaker Donna G, De Smet Arthur A, Keene James S
Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252, USA.
Skeletal Radiol. 2006 Aug;35(8):565-71. doi: 10.1007/s00256-006-0084-6. Epub 2006 Mar 29.
The purpose of this study was to compare sonographic evaluations of patients referred with suspected snapping of their iliopsoas tendon with the pain relief achieved from anesthetic injection of the iliopsoas bursa, and with the subsequent surgical outcome. This study also assessed the effectiveness of Kenalog injection into the iliopsoas bursa for long-term pain relief.
Dynamic and static sonography was performed in 40 patients with clinically diagnosed snapping hips. The iliopsoas bursa was injected with Bupivicaine and Lidocaine in the first 22 patients, and an additional 1 ml Kenalog-40 was added to this mixture in the last 18 patients. We compared the static and dynamic sonographic findings with change in the patients' level of pain at 2 days after anesthetic injection. The sonographic findings and response to anesthetic injection were also compared to the response to Kenalog injection and the results of any subsequent surgery.
Static sonography of the iliopsoas tendon was normal in 38 patients, and detected iliopsoas bursitis in one patient and iliopsoas tendinopathy in another. Snapping of the iliopsoas tendon was observed using dynamic sonography in 9 of the 40 patients. Following anesthetic injection of the iliopsoas bursa, 29 patients had complete or partial pain relief, and 11 patients had no pain relief. Eight of the nine patients with a snapping iliopsoas tendon had complete or partial pain relief from the bursal injection. Twelve of the 29 patients with pain relief after anesthetic injection later had an arthroscopic iliopsoas tendon release, and all of these 12 patients had a good postoperative result. Of the 18 patients who had Kenalog-40 injected into the iliopsoas bursa and did not have iliopsoas surgery, 16 had sustained pain relief following the injection.
Patients with groin pain and a clinically suspected snapping iliopsoas tendon can benefit from injection into the iliopsoas bursa even if the snapping tendon is not visualized sonographically. The use of a corticosteroid may provide long-term pain relief, and pain relief after injection is a predictor of good outcome after surgical release of the iliopsoas tendon.
本研究旨在比较对疑似髂腰肌肌腱弹响患者的超声评估结果、髂腰肌滑囊麻醉注射后的疼痛缓解情况以及后续手术结果。本研究还评估了向髂腰肌滑囊注射曲安奈德实现长期疼痛缓解的有效性。
对40例临床诊断为弹响髋的患者进行动态和静态超声检查。前22例患者的髂腰肌滑囊注射了布比卡因和利多卡因，后18例患者在此混合物中额外添加了1毫升曲安奈德-40。我们将静态和动态超声检查结果与麻醉注射后2天患者疼痛程度的变化进行了比较。超声检查结果及对麻醉注射的反应也与对曲安奈德注射的反应以及任何后续手术的结果进行了比较。
38例患者的髂腰肌肌腱静态超声检查正常，1例患者检测出髂腰肌滑囊炎，另1例患者检测出髂腰肌肌腱病。40例患者中有9例在动态超声检查中观察到髂腰肌肌腱弹响。髂腰肌滑囊麻醉注射后，29例患者疼痛完全或部分缓解，11例患者疼痛未缓解。9例髂腰肌肌腱弹响患者中有8例经滑囊注射后疼痛完全或部分缓解。29例麻醉注射后疼痛缓解的患者中有12例后来接受了关节镜下髂腰肌肌腱松解术，所有这12例患者术后效果良好。在18例向髂腰肌滑囊注射曲安奈德-40且未进行髂腰肌手术的患者中，16例注射后疼痛持续缓解。
即使超声未显示弹响肌腱，腹股沟疼痛且临床疑似髂腰肌肌腱弹响的患者也可从髂腰肌滑囊注射中获益。使用皮质类固醇可能会提供长期疼痛缓解，注射后疼痛缓解是髂腰肌肌腱手术松解后良好预后的预测指标。
