Zeman P, Cibulková J, Kormunda S, Koudela K, Nepraš P, Matějka J
Klinika ortopedie a traumatologie pohybového ústrojí LF UK a FN v Plzni.
Acta Chir Orthop Traumatol Cech. 2013;80(4):263-72.
In this prospective randomised study, the short-term results of arthroscopic transcapsular iliopsoas tenotomy approached from the peripheral versus the central compartment for internal snapping hip syndrome are presented.
A group of 19 patients (15 women and four men; mean age, 24.3 years) who underwent arthroscopic transcapsular iliopsoas tenotomy for internal snapping hip syndrome in the period between September 2010 and December 2011 were prospectively evaluated. No injury, hip surgery or feeling of hip instability was recorded in their personal histories. Radiographs did not show any dysplasia, retroversion of the acetabulum or cam lesions. The patients were allocated to two groups using sealed envelope randomisation: Group 1 patients (n=10) were treated by tenotomy from the peripheral compartment and group 2 patients (n=9) underwent tenotomy from the central compartment during traction of the lower extremity. The evaluation included pre-operative 3T MRI findings, arthroscopically detected intra-articular lesions, duration of traction and post-operative complications. The pre-operative WOMAC scores were compared with those at one-year follow-up. In comparison of the two groups, the Mann-Whitney exact test was used for WOMAC scores and Fisher's exact test for post-operative complications. Statistical significance was set at a 0.05 level.
In comparing post-operative complications, a significant difference (p=0.0468) between the groups was found only for genital paresthesia, which did not occur in group 1. The other differences were not statistically significant. The pre-operative WOMAC scores did not differ significantly between the groups (p=0.79). The post-operative WOMAC scores were significantly higher in group 1 (p=0.02). In each group the change in WOMAC scores was different and was statistically significant in group 1 (p=0.0014). Associated intra-articular hip pathologies, most frequently synovitis of the peripheral compartment, acetabular chondropathy, or labral lesions, were diagnosed in 90% of group 1 patients and in 66.7% of group 2 patients.
Most of the authors comparing the results of two different ilioproas tenotomy techniques at one-year follow-up did not report any statistically significant differences in WOMAC scores between them. In accordance with the data reported, an increase in the post-operative WOMAC score, i.e., improvement of clinical outcome, was achieved in all our patients and, in group 1, it was significantly higher (p=0.0015), as compared with a similar study by Ilizaliturri. However, further follow-up of the patients and evaluation of long-term results will be necessary.
The technique of arthroscopic ilioproas tenotomy approached from the peripheral compartment resulted in significantly fewer cases of genital paresthesia and provided significantly better clinical outcomes in comparison with tenotomy from the central compartment.
在这项前瞻性随机研究中，我们展示了经关节镜下经囊髂腰肌松解术分别从髋关节外侧间室和中央间室入路治疗弹响髋综合征的短期结果。
前瞻性评估了一组19例患者（15例女性和4例男性；平均年龄24.3岁），这些患者在2010年9月至2011年12月期间因弹响髋综合征接受了关节镜下经囊髂腰肌松解术。他们的个人病史中均无损伤、髋关节手术或髋关节不稳定感的记录。X线片未显示任何发育异常、髋臼后倾或凸轮样病变。采用密封信封随机法将患者分为两组：第1组患者（n = 10）通过外侧间室入路进行松解术，第2组患者（n = 9）在下肢牵引下通过中央间室进行松解术。评估内容包括术前3T MRI检查结果、关节镜下发现的关节内病变、牵引时间及术后并发症。将术前WOMAC评分与1年随访时的评分进行比较。在两组比较中，WOMAC评分采用Mann-Whitney精确检验，术后并发症采用Fisher精确检验。设定统计学显著性水平为0.05。
在比较术后并发症时，仅在生殖器感觉异常方面两组间存在显著差异（p = 0.0468），第1组未出现该并发症。其他差异无统计学意义。两组术前WOMAC评分无显著差异（p = 0.79）。第1组术后WOMAC评分显著更高（p = 0.02）。每组中WOMAC评分的变化不同，且第1组具有统计学显著性（p = 0.0014）。第1组90%的患者和第2组66.7%的患者被诊断出存在相关的髋关节关节内病变，最常见的是外侧间室滑膜炎、髋臼软骨病或盂唇病变。
大多数在1年随访时比较两种不同髂腰肌松解术结果的作者并未报告两组间WOMAC评分存在任何统计学显著差异。根据所报告的数据，我们所有患者的术后WOMAC评分均有所增加，即临床结局得到改善，并且在第1组中，与Ilizaliturri的类似研究相比，该评分显著更高（p = 0.0015）。然而，有必要对患者进行进一步随访并评估长期结果。
与从中央间室入路的松解术相比，经关节镜下从外侧间室入路进行髂腰肌松解术导致生殖器感觉异常的病例显著减少，并且临床结局显著更好。
