Cascio Brett M, King David, Yen Yi-Meng
Lake Charles Memorial Hospital, New Orleans, USA.
J La State Med Soc. 2013 Mar-Apr;165(2):88-93.
The term hip impingement is usually associated with psoas impingement after arthroplasty or femoroacetabular impingement (FAI). A recently, less commonly described mechanism of impingement and labrum pathology is the psoas tendon applying pressure to the acetabular labrum more medial to the typical FAI labrum lesion. Much is still unkown about the anatomy, pathology, and treatment of this entity.
This paper describes the successful arthroscopic treatment of a series of patients with a recently recognized cause of hip pain in the young athletic population without significant bony pathology or coxa saltans. Awareness of this entity is important to allow appropriate treatment of the labrum and psoas tendon.
Seven hundred hip arthroscopies by three surgeons at different centers were retrospectively reviewed. Athletes with labrum tears from the two to three o'clock position were evaluated for inclusion in the study. Patients with osteoarthritis, crossover sign, coxa profunda, CAM lesion, acute trauma, or coxa saltans were excluded. All authors were the primary surgeons and are fellowship-trained hip arthroscopists working in tertiary hip arthroscopy centers. Pre- and postoperative Harris Hip scores were obtained. Patients underwent diagnostic and therapeutic hip arthroscopy. The psoas tendon was released in all patients at the level of the capsule via a transcapsular approach. Labrum repairs were performed when deemed beneficial by the operative surgeon.
Twenty-two patients (26 hips, 4 bilateral) were identified with a labrum tear apparently caused by psoas impingement and had no other significant hip abnormalities. All but one were female. Average age was 19 (12-25 years). Labral repair was performed in all but two patients. Average anchors used were 1.2 per hip. Pre- and postoperative Harris hip scores were obtained with a minimum follow-up of six months for 16 patients. Average Harris hip score improved from 70 preop to 94 postop. There were no significant complications identified.
We describe a recently recognized entity encountered in the treatment of athletes with hip pain consisting of labrum pathology associated with the psoas tendon rather than bony abnormality. Arthroscopic treatment, including a psoas tendon release and a more medial labrum repair, can provide relief with no significant complications in the short term.
Understanding the unique pathoanatomy of this entity may allow the surgeon to provide more thorough informed consent, prepare for a more medial labrum repair than usual, and provide appropriate referral when necessary.
“髋关节撞击症”这一术语通常与关节置换术后的腰大肌撞击症或股骨髋臼撞击症（FAI）相关。最近，一种较少被描述的撞击症和盂唇病变机制是腰大肌肌腱对髋臼盂唇施加压力，其位置比典型的FAI盂唇病变更靠内侧。关于这一病症的解剖结构、病理变化及治疗方法，仍有许多未知之处。
本文描述了一系列年轻运动员人群中近期被认识到的导致髋关节疼痛的病因，且无明显骨质病变或跳跃征，对其进行关节镜治疗取得成功。认识这一病症对于对盂唇和腰大肌肌腱进行恰当治疗很重要。
回顾性分析了不同中心的三位外科医生进行的700例髋关节镜检查。评估两到三点位置盂唇撕裂的运动员是否纳入研究。排除骨关节炎、交叉征、髋臼过深、凸轮病变、急性创伤或跳跃征患者。所有作者均为主要外科医生，且是在三级髋关节镜中心接受过 fellowship 培训的髋关节镜专家。获取术前和术后的 Harris 髋关节评分。患者接受诊断性和治疗性髋关节镜检查。所有患者均通过经关节囊入路在关节囊水平松解腰大肌肌腱。手术医生认为有必要时进行盂唇修复。
确定22例患者（26个髋关节，4例双侧）的盂唇撕裂明显由腰大肌撞击所致，且无其他明显的髋关节异常。除1例为男性外，其余均为女性。平均年龄为19岁（12 - 25岁）。除2例患者外，其余均进行了盂唇修复。平均每个髋关节使用1.2个锚钉。对16例患者进行了至少6个月的随访，并获取术前和术后的 Harris 髋关节评分。平均 Harris 髋关节评分从术前的70分提高到术后的94分。未发现明显并发症。
我们描述了在治疗髋关节疼痛的运动员时最近认识到的一种病症，其由与腰大肌肌腱相关而非骨性异常的盂唇病变组成。关节镜治疗，包括腰大肌肌腱松解和更靠内侧的盂唇修复，短期内可缓解症状且无明显并发症。
了解这一病症独特的病理解剖结构可使外科医生提供更全面的知情同意，为比平常更靠内侧的盂唇修复做好准备，并在必要时提供适当的转诊。
