Davies Hywel, Zhaeentan Sohelia, Tavakkolizadeh Adel, Janes Gregory
Avon Orthopaedic Centre, Bristol, UK.
Hip Int. 2009 Oct-Dec;19(4):372-6. doi: 10.1177/112070000901900412.
Lateral sided hip pain frequently presents to the orthopaedic clinic. The most common cause of this pain is trochanteric bursitis. This usually improves with conservative treatment. In a few cases it doesn't settle and warrants further investigation and treatment. We present a series of 28 patients who underwent MRI scanning for such pain, 16 were found to have a tear of their abductors. All 16 underwent surgical repair using multiple soft tissue anchors inserted into the greater trochanter of the hip to reattach the abductors. There were 15 females and 1 male. All patients completed a self-administered questionnaire pre-operatively and 1 year post-operatively. Data collected included: A visual analogue score for hip pain, Charnley modification of the Merle D'Aubigne and Postel hip score, Oxford hip score, Kuhfuss score of Trendelenburg and SF36 scores.Of the 16 patients who underwent surgery 5 had a failure of surgical treatment. There were 4 re ruptures, 3 of which were revised and 1 deep infection which required debridement. In the remaining 11 patients there were statistically significant improvements in hip symptoms. The mean change in visual analogue score was 5 out of 10 (p=0.0024) The mean change of Oxford hip score was 20.5 (p=0.00085). The mean improvement in SF-36 PCS was 8.5 (P=0.0020) and MCS 13.7 (P=0.134). 6 patients who had a Trendelenburg gait pre-surgery had normal gait 1 year following surgery.We conclude that hip abductor mechanism tear is a frequent cause of recalcitrant trochanteric pain that should be further investigated with MRI scanning. Surgical repair is a successful operation for reduction of pain and improvement of function. However there is a relatively high failure rate.
髋关节外侧疼痛经常出现在骨科门诊。这种疼痛最常见的原因是转子滑囊炎。通常通过保守治疗可改善。在少数情况下，病情无法缓解，需要进一步检查和治疗。我们报告了一组28例因这种疼痛接受磁共振成像（MRI）扫描的患者，其中16例发现有外展肌撕裂。所有16例患者均接受了手术修复，使用多个软组织锚钉插入髋关节大转子以重新附着外展肌。其中有15名女性和1名男性。所有患者在术前和术后1年都完成了一份自我管理的问卷。收集的数据包括：髋关节疼痛的视觉模拟评分、Charnley改良的Merle D'Aubigne和Postel髋关节评分、牛津髋关节评分、Trendelenburg的Kuhfuss评分以及SF36评分。在接受手术的16例患者中，有5例手术治疗失败。有4例再次撕裂，其中3例进行了翻修，1例深部感染需要清创。在其余11例患者中，髋关节症状有统计学意义的改善。视觉模拟评分的平均变化为10分中的5分（p = 0.0024）。牛津髋关节评分的平均变化为20.5（p = 0.00085）。SF - 36生理健康评分（PCS）的平均改善为8.5（P = 0.0020），心理健康评分（MCS）为13.7（P = 0.134）。6例术前有Trendelenburg步态的患者术后1年步态正常。我们得出结论，髋关节外展肌机制撕裂是顽固性转子疼痛的常见原因，应通过MRI扫描进一步检查。手术修复是减轻疼痛和改善功能的成功手术。然而，失败率相对较高。
