Hospital for Special Surgery, New York, New York, USA.
Arthroscopy. 2012 Jul;28(7):965-71. doi: 10.1016/j.arthro.2011.11.028. Epub 2012 Feb 1.
The purpose of this study was to examine the association between femoral anteversion and clinical outcomes after arthroscopic lengthening of a symptomatic, snapping psoas tendon in young patients.
Sixty-seven consecutive patients with symptomatic coxa saltans underwent arthroscopic psoas tendon lengthening through a transcapsular approach during a 3-year period by a single arthroscopic hip surgeon. Demographic and clinical variables were collected. Patients were divided into low/normal femoral version and high femoral version groups and analyzed for association of femoral version with clinical outcomes as measured by the modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) preoperatively and postoperatively with a minimum of 6 months' follow-up (range, 6 to 24 months). Two-sample t tests were used for data analysis, with P < .05 defined as significant.
Preoperative evaluation showed excessive anteversion (>25°) associated with worse HOS sports subscale scores (26.6 v 50.0 for excessive v low/normal anteversion, P = .013) and no difference in mHHS and HOS activities-of-daily living subscale scores. Postoperative mHHS scores were significantly different (76.9 v 86.1 for excessive v low/normal anteversion, P = .031). No association was noted between clinical outcome measures and any other clinical or demographic variable (P > .05).
Patients with increased femoral anteversion may be at greater risk for inferior clinical outcomes after arthroscopic lengthening of a symptomatic, snapping psoas tendon. The psoas tendon may be an important passive and dynamic stabilizer of the hip in these patients, and release may result in a greater alteration of kinematics with high-demand activities, particularly terminal extension and external rotation when the tendon is typically at its highest tension. These results may help surgeons identify which patients may be at risk for inferior clinical outcome after psoas lengthening.
本研究旨在探讨髋关节镜下治疗青年症状性弹响性髂腰肌肌腱延长术后股骨前倾角与临床疗效的关系。
在 3 年期间，由一位关节镜髋关节外科医生通过经关节囊入路对 67 例症状性弹响性髂腰肌肌腱的患者进行了髋关节镜下髂腰肌肌腱延长术。收集了患者的人口统计学和临床资料。根据术前股骨前倾角将患者分为低/正常组和高组，并对两组患者进行分析，评估股骨前倾角与改良 Harris 髋关节评分（mHHS）和髋关节评分（HOS）的关系，评估指标包括术前和术后至少 6 个月的随访（6-24 个月）。采用两样本 t 检验进行数据分析，P <.05 为差异有统计学意义。
术前评估显示，过度前倾角（>25°）与 HOS 运动亚量表评分较差相关（过度前倾角为 26.6，低/正常前倾角为 50.0，P =.013），而 mHHS 和 HOS 日常生活活动量表评分无差异。术后 mHHS 评分差异有统计学意义（过度前倾角为 76.9，低/正常前倾角为 86.1，P =.031）。未发现临床结局测量指标与任何其他临床或人口统计学变量之间存在关联（P >.05）。
股骨前倾角增加的患者在接受症状性弹响性髂腰肌肌腱的髋关节镜下延长术后可能存在较差的临床结果的风险。在这些患者中，髂腰肌肌腱可能是髋关节的一个重要的被动和动力稳定因素，当肌腱处于最高张力时，释放可能导致运动学的更大改变，特别是在高需求的活动中，尤其是在终末伸展和外旋时。这些结果可能有助于外科医生识别哪些患者在接受髂腰肌延长术后可能存在临床结果不佳的风险。
