Wilson Shayne A, Shanahan Ernst M, Smith Malcolm D
Department of Medicine, The Queen Elizabeth Hospital Adelaide, Adelaide, South Australia, Australia.
Int J Rheum Dis. 2014 Jul;17(6):621-7. doi: 10.1111/1756-185X.12250. Epub 2013 Dec 6.
To assess the outcomes for patients seen in a rheumatology service presenting with features of the greater trochanteric pain syndrome (GTPS) and the impact of imaging results on the outcomes of treatment.
Retrospective audit, using a phone interview was performed to establish links between results of imaging undertaken in the diagnostic work-up of patients with lateral hip pain and clinical outcomes for these patients. Patient perceptions of the effectiveness of interventions were also assessed.
Forty-five patients were included (82% female, mean age 69.6 years). Sixty-nine percent underwent radiological work-up, including plain X-rays (55%), computed tomography scans (64%), magnetic resonance imaging (48%) and ultrasound (90%). Coexistent trochanteric bursitis (TB) and gluteal tendinopathy were the most commonly elucidated pathologies accounting for the symptomatic presentation of 40% of patients. Forty-one patients underwent some form of intervention, most commonly injection of local anesthetic and corticosteroid (LACS) into the region of the TB (87%), two-thirds of which were undertaken under radiological guidance. Pain reduction was maximal following the third injection, with a significantly better response to unguided interventions and levels of symptomatic relief following the first injection being a good indicator of the probability of complete remission. Radiological demonstration of isolated TB correlated with a greater reduction in lateral hip symptoms following LACS TB injections both in the immediate post-injection phase and in the long-term.
The results of this audit suggest that the management of GTPS has reasonable patient outcomes; however, a prospective study with greater patient numbers is needed to confirm these results.
评估在风湿病科就诊的表现为大转子疼痛综合征（GTPS）特征的患者的治疗结果，以及影像学结果对治疗结果的影响。
采用电话访谈进行回顾性审计，以建立在外侧髋部疼痛患者诊断检查中所做影像学检查结果与这些患者临床结果之间的联系。还评估了患者对干预措施有效性的看法。
纳入45例患者（82%为女性，平均年龄69.6岁）。69%的患者接受了放射学检查，包括普通X线检查（55%）、计算机断层扫描（64%）、磁共振成像（48%）和超声检查（90%）。并存的转子滑囊炎（TB）和臀肌肌腱病是最常见的明确病变，占40%有症状患者的症状表现原因。41例患者接受了某种形式的干预，最常见的是在TB区域注射局部麻醉剂和皮质类固醇（LACS）（87%），其中三分之二是在放射学引导下进行的。第三次注射后疼痛减轻最大，无引导干预的反应明显更好，第一次注射后的症状缓解程度是完全缓解可能性的良好指标。孤立性TB的放射学表现与LACS TB注射后即刻及长期外侧髋部症状的更大减轻相关。
本次审计结果表明，GTPS的治疗有合理的患者治疗结果；然而，需要进行一项纳入更多患者的前瞻性研究来证实这些结果。
