Department of Orthopaedic Surgery, Aurora Sinai Medical Center, 945 North 12th Street, Suite 1200, Milwaukee, WI 53233, USA.
J Bone Joint Surg Am. 2013 Aug 7;95(15):1420-5. doi: 10.2106/JBJS.L.00709.
Greater trochanteric pain syndrome is a common orthopaedic condition related to underlying bursitis, but it may reflect gluteal tendinopathy with tendon disruption from the greater trochanter. Our goal was to evaluate our clinical experience with surgical repair of these tears.
We retrospectively evaluated a consecutive series of twenty-two patients (twenty-three hips) with a tear of the hip abductor tendons who underwent surgical reconstruction and were followed for a minimum of five years. The preoperative evaluation revealed chronic lateral hip pain, a positive Trendelenburg sign, and a tear documented by magnetic resonance imaging (MRI). The tears were defined intraoperatively with a four-tiered scheme that accounted for the dimension of the tear ranging from partial-thickness undersurface tears to complete tears of the gluteus muscle tendon insertion.
The mean Harris hip score improved from 53 points preoperatively to 87 points at one year and 88 points at five years. The mean Lower-Extremity Activity Scale score improved from 6.7 points preoperatively to 8.9 points at one year and 8.8 points at five years. With the numbers available, no significant difference in the degree of clinical improvement was found on the basis of the severity of the tear. However, the three patients with poor results were in the group with the largest tears. Overall, sixteen of nineteen patients were satisfied with their surgical result and were willing to undergo the procedure again if necessary.
Surgical repair of torn abductor tendons of the hip is a viable option when MRI and clinical findings are consistent with tendon disruption and weakness. There was substantial and durable improvement in strength and clinical performance in most cases.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
大转子疼痛综合征是一种常见的骨科疾病，与潜在的滑囊炎有关，但它也可能反映出臀大肌肌腱炎，伴有从大转子撕裂的肌腱。我们的目标是评估我们在这些撕裂的手术修复方面的临床经验。
我们回顾性评估了 22 例（23 髋）接受髋关节外展肌肌腱修复手术的患者连续系列，随访时间至少 5 年。术前评估显示慢性髋关节外侧疼痛、Trendelenburg 征阳性和 MRI 检查证实的撕裂。术中采用四层次方案定义撕裂，考虑撕裂的大小，从部分厚度下表面撕裂到臀大肌肌腱插入处的完全撕裂。
Harris 髋关节评分从术前的 53 分提高到 1 年时的 87 分和 5 年时的 88 分。下肢活动量表评分从术前的 6.7 分提高到 1 年时的 8.9 分和 5 年时的 8.8 分。根据撕裂的严重程度，在临床改善的程度上，没有发现有统计学差异。然而，在结果较差的 3 名患者中，撕裂最大。总的来说，19 名患者中有 16 名对手术结果满意，如果有必要，他们愿意再次接受手术。
当 MRI 和临床检查结果与肌腱断裂和无力一致时，髋关节外展肌撕裂的手术修复是一种可行的选择。在大多数情况下，力量和临床表现都有显著和持久的改善。
治疗级别 IV。请参阅作者说明，以获取完整的证据级别描述。
