Braun K F, Siebenlist S, Sandmann G, Martetschläger F, Kraus T, Ehnert S, Neumaier M, Freude T, Stöckle U
Klinik und Poliklinik für Unfallchirurgie, Klinikum Rechts der Isar, Technische Universität München.
Orthopade. 2012 Mar;41(3):212-6. doi: 10.1007/s00132-012-1902-2.
Chronic and atraumatic groin pain may be due to a variety of pathologies local to and distal from the hip joint. Aside from frequent entities, such as inguinal hernia, impingement of the iliopsoas muscle by the anterior rim of the acetabular component leading to a hematoma can be a potential cause after total hip replacement (THR).
This article presents three cases of delayed groin pain after THR received due to osteoarthrosis of the hip joint several years prior to the onset of symptoms. In all three cases the patient suffered from chronic groin pain aggravated by active flexion without direct trauma. After thorough clinical, laboratory and radiological (ultrasound, x-ray, computed tomography) examination a hematoma of the iliopsoas muscle was detected. Furthermore, in all three cases the acetabular component appeared to be slightly malpositioned. Considering the least invasive procedure all cases were treated with an excavation of the hematoma. After recurrence the indications for revision of the malpositioned acetabular component were present.
All patients clearly showed a reduction of pain after operative revision. There have been no further hematomas and the patients could be easily and rapidly remobilized.
Persistent atraumatic groin pain connected to a deficit in hip flexion after THR needs thorough investigation by the treating physician. The differential diagnosis of a delayed hematoma due to impingement of the iliopsoas muscle is a rare but more complex entity. After careful consideration of the perioperative risks an early indication for revision of a malpositioned acetabular component is promising.
慢性非创伤性腹股沟疼痛可能由髋关节局部及远处的多种病变引起。除常见病因外，如腹股沟疝，全髋关节置换术（THR）后，髋臼假体前缘撞击髂腰肌导致血肿也可能是潜在病因。
本文介绍了3例因髋关节骨关节炎在数年前接受THR，数年后出现延迟性腹股沟疼痛的病例。所有3例患者均患有慢性腹股沟疼痛，主动屈曲时疼痛加剧，无直接外伤史。经过全面的临床、实验室及影像学（超声、X线、计算机断层扫描）检查，均发现髂腰肌血肿。此外，所有3例患者的髋臼假体均有轻度位置不当。考虑到手术创伤最小，所有病例均采用血肿清除术治疗。复发后，有指征对位置不当的髋臼假体进行翻修。
所有患者术后翻修后疼痛均明显减轻。未再出现血肿，患者能够轻松快速地恢复活动。
THR后持续存在的非创伤性腹股沟疼痛且伴有髋关节屈曲功能障碍，需要治疗医生进行全面检查。髂腰肌撞击导致延迟性血肿的鉴别诊断虽罕见但更为复杂。仔细考虑围手术期风险后，早期对位置不当的髋臼假体进行翻修有望取得良好效果。
