Moulton Kyle M, Aly Abdel-Rahman, Rajasekaran Sathish, Shepel Michael, Obaid Haron
Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada,
Skeletal Radiol. 2015 Jan;44(1):47-54. doi: 10.1007/s00256-014-1991-6. Epub 2014 Aug 27.
Gluteal tendinopathy and greater trochanteric pain syndrome (GTPS) remain incompletely understood despite their pervasiveness in clinical practice. To date, no study has analyzed the morphometric characteristics of the hip on magnetic resonance imaging (MRI) that may predispose to gluteal tendinopathy. This study aimed to evaluate whether acetabular anteversion (AA), femoral neck anteversion (FNA), and femoral neck-shaft angle (FNSA) are associated with MRI features of gluteal tendinopathy.
A total of 203 MRI examinations of the hip met our inclusion and exclusion criteria. A single blinded investigator measured AA, FNA, and FNSA according to validated MRI techniques. Two blinded subspecialty-trained musculoskeletal radiologists then independently evaluated the presence of gluteal tendinosis, trochanteric bursitis, and subgluteal bursitis. Statistical analysis was performed using a one-way analysis of variance (ANOVA; post-hoc Tukey's range test).
At MRI, 57 patients had gluteal tendinosis with or without bursitis, 26 had isolated trochanteric bursitis, and 11 had isolated subgluteal bursitis. AA was significantly (p = 0.01) increased in patients with MRI evidence of gluteal tendinosis with or without bursitis [mean: 18.4°, 95 % confidence interval (CI): 17.2°-19.6°] compared with normal controls (mean: 15.7°, 95 % CI: 14.7°-16.8°). Similarly, AA was significantly (p = 0.04) increased in patients with isolated trochanteric bursitis (mean: 18.8°, 95 % CI: 16.2°-21.6°). No association was found between FNA or FNSA and the presence of gluteal tendinopathy. Interobserver agreement for the presence and categorization of gluteal tendinopathy was very good (kappa = 0.859, 95 % CI: 0.815-0.903).
Our MRI study suggests that there is an association between increased AA and gluteal tendinopathy, which supports a growing body of evidence implicating abnormal biomechanics in the development of this condition.
尽管臀肌肌腱病和大转子疼痛综合征（GTPS）在临床实践中普遍存在，但对其仍未完全了解。迄今为止，尚无研究分析可能易患臀肌肌腱病的髋关节在磁共振成像（MRI）上的形态学特征。本研究旨在评估髋臼前倾角（AA）、股骨颈前倾角（FNA）和股骨颈干角（FNSA）是否与臀肌肌腱病的MRI特征相关。
共有203例髋关节MRI检查符合我们的纳入和排除标准。一名单盲研究者根据经过验证的MRI技术测量AA、FNA和FNSA。然后，两名经过亚专业培训的盲法肌肉骨骼放射科医生独立评估臀肌肌腱病、转子滑囊炎和臀下滑囊炎的存在情况。采用单因素方差分析（ANOVA；事后Tukey范围检验）进行统计分析。
在MRI检查中，57例患者有臀肌肌腱病伴或不伴滑囊炎，26例有孤立性转子滑囊炎，11例有孤立性臀下滑囊炎。与正常对照组（平均值：15.7°，95%置信区间[CI]：14.7°-16.8°）相比，有MRI证据显示有臀肌肌腱病伴或不伴滑囊炎的患者AA显著增加（p = 0.01）[平均值：18.4°，95% CI：17.2°-19.6°]。同样地，孤立性转子滑囊炎患者的AA也显著增加（p = 0.04）（平均值：18.8°，95% CI：16.2°-21.6°）。未发现FNA或FNSA与臀肌肌腱病之间存在关联。观察者之间对臀肌肌腱病的存在和分类的一致性非常好（kappa = 0.859，95% CI：0.815-0.903）。
我们的MRI研究表明，AA增加与臀肌肌腱病之间存在关联，这支持了越来越多的证据表明异常生物力学与这种疾病的发生有关。
