El Bitar Youssef F, Stake Christine E, Dunne Kevin F, Botser Itamar B, Domb Benjamin G
Hinsdale Orthopaedics/American Hip Institute, Westmont, Illinois, USA.
Hinsdale Orthopaedics/American Hip Institute, Westmont, Illinois, USA
Am J Sports Med. 2014 Jul;42(7):1696-703. doi: 10.1177/0363546514531037. Epub 2014 Apr 25.
Internal snapping of the hip is caused by the iliopsoas (IP) tendon sliding over the iliopectineal eminence or the femoral head. In many cases that require hip arthroscopic surgery, there is coexistent painful internal snapping. In such cases, fractional lengthening of the IP tendon has been suggested as an adjunctive procedure.
To examine the outcomes and effectiveness of arthroscopic IP tendon fractional lengthening as a solution to coexistent internal hip snapping in patients undergoing hip arthroscopic surgery for a labral tear and/or femoroacetabular impingement.
Case series; Level of evidence, 4.
Between June 2010 and June 2011, data were prospectively collected for all patients with internal snapping of the hip who underwent primary arthroscopic IP tendon fractional lengthening, with a minimum 2-year follow-up. All patients were interviewed by telephone with specific questions regarding the resolution or persistence of snapping. Patients were assessed preoperatively and postoperatively using the following patient-reported outcome (PRO) measures: Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and modified Harris Hip Score (mHHS). Pain was recorded on a visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10.
A total of 55 patients were included, with all PROs showing statistically significant improvement postoperatively (NAHS: 57.6 ± 20.6 preoperatively vs. 80.2 ± 19.2 at 2 years; HOS-ADL: 60.9 ± 21.4 preoperatively vs. 81.8 ± 20.6 at 2 years; HOS-SSS: 43.4 ± 24.6 preoperatively vs. 70.0 ± 26.7 at 2 years; and mHHS: 62.3 ± 16.4 preoperatively vs. 80.5 ± 18.3 at 2 years) (P < .001 for all). Forty-five patients (81.8%) reported good/excellent satisfaction (≥7). Overall, 45 patients (81.8%) reported resolution of painful snapping. Patients who had resolution of snapping had statistically significant superior outcomes compared with those with persistent snapping using the change in the NAHS value (25.8 ± 16.1 vs. 8.0 ± 22.5, respectively; P = .005), change in the HOS-ADL value (23.6 ± 18.0 vs. 8.5 ± 15.2, respectively; P = .017), change in the HOS-SSS value (30.7 ± 26.9 vs. 8.7 ± 23.6, respectively; P = .021), and change in the mHHS value (23.3 ± 20.1 vs. 4.4 ± 9.9, respectively; P = .005).
A majority of patients reported resolution of painful snapping and improvement in symptoms. Nonetheless, the rate of persistence of internal snapping at a minimum 2 years postoperatively was higher than that reported in previous studies.
髋关节内弹响是由髂腰肌（IP）肌腱在髂耻隆起或股骨头表面滑动所致。在许多需要进行髋关节镜手术的病例中，同时存在疼痛性内弹响。在这类病例中，有人建议对IP肌腱进行部分延长作为辅助手术。
探讨关节镜下IP肌腱部分延长术治疗因髋臼盂唇撕裂和/或股骨髋臼撞击症接受髋关节镜手术的患者合并的髋关节内弹响的疗效和有效性。
病例系列；证据等级，4级。
2010年6月至2011年6月，前瞻性收集所有接受初次关节镜下IP肌腱部分延长术且至少随访2年的髋关节内弹响患者的数据。通过电话对所有患者进行访谈，询问有关弹响消失或持续存在的具体问题。术前和术后使用以下患者报告结局（PRO）指标对患者进行评估：非关节炎髋关节评分（NAHS）、髋关节结局评分-日常生活活动（HOS-ADL）和运动特定子量表（HOS-SSS），以及改良Harris髋关节评分（mHHS）。采用视觉模拟量表（VAS）记录疼痛情况，满意度采用0至10分的量表进行测量。
共纳入55例患者，所有PRO指标术后均有统计学意义的改善（NAHS：术前57.6±20.6，2年时为80.2±19.2；HOS-ADL：术前60.9±21.4，2年时为81.8±20.6；HOS-SSS：术前43.4±24.6，2年时为70.0±26.7；mHHS：术前62.3±16.4，2年时为80.5±18.3）（所有P<0.001）。45例患者（81.8%）报告满意度良好/优秀（≥7分）。总体而言，45例患者（81.8%）报告疼痛性弹响消失。与弹响持续存在的患者相比，弹响消失的患者在NAHS值变化（分别为25.8±16.1和8.0±22.5；P = 0.005）、HOS-ADL值变化（分别为23.6±18.0和8.5±15.2；P = 0.017）、HOS-SSS值变化（分别为30.7±26.9和8.7±23.6；P = 0.021）以及mHHS值变化（分别为23.3±20.1和4.4±9.9；P = 0.005）方面具有统计学意义的更好结局。
大多数患者报告疼痛性弹响消失且症状改善。尽管如此，术后至少2年内内弹响持续存在的发生率高于先前研究报告的发生率。
