Orava Sakari, Hetsroni Iftach, Marom Niv, Mann Gideon, Sarimo Janne, Ben-Zvi Ofer, Lempainen Lasse
Hospital NEO and Sports Research Unit, Turku, Finland.
Orthopedic Department, Meir General Hospital, Kfar Saba, Israel Sackler Faculty of Medicine, Tel-Aviv University, Israel
Am J Sports Med. 2015 Jun;43(6):1331-6. doi: 10.1177/0363546515574065. Epub 2015 Mar 19.
Proximal hamstring tears can be associated with chronic disability related to the unusual formation of heterotopic ossifications. The role for operative intervention in these circumstances has not been clearly defined.
PURPOSE/HYPOTHESIS: The purpose of this study was to describe the surgical management of young athletes who had chronic disability related to proximal hamstring ossifications after eccentric load injuries. The hypothesis was that after surgical excision of posttraumatic heterotopic ossifications at the proximal hamstrings with concomitant repair of the tendons to the ischium, significant functional improvement with low risk of postoperative complications can be expected at minimum 2-year follow-up.
Case series; Level of evidence, 4.
The cases of 11 consecutive male athletes who developed chronic disability associated with heterotopic ossifications at the proximal hamstring muscles after sports-related tears were reviewed. During surgery, the ossified mass was meticulously excised, and the tendons were debrided and fixed to the ischium. At minimum 2-year follow-up, self-reported outcome was rated as excellent, good, moderate, or poor. Operative reports and office visits were reviewed. Activity level before the injury and at latest follow-up was graded with the Tegner scale.
The median age at injury was 17 years (range, 13-25 years). Sports activities included ice hockey, soccer, track and field athletics, and judo. Mean interval from injury to surgery was 45 months. The smallest ossified mass was 2 × 2 × 4 cm and the largest, 3 × 4 × 9 cm. Median follow-up was 4 years (range, 2-10 years). Six patients had excellent, 1 patient had good, and 4 patients had moderate outcomes; 7 of them were able to return to preinjury activities (Tegner score, 7-10). There were 2 cases of loss of skin sensation at the posterior femoral cutaneous nerve distribution, but neither patient described this as significantly interfering with any activity. All patients had symmetric side-to-side single-legged hop test and a 5 out of 5 on hamstring muscle strength at latest follow-up.
Heterotopic ossifications that develop at the proximal hamstrings after eccentric load injuries can be associated with significant chronic disability. These cases can be effectively treated by surgical excision of the ossified masses and concomitant debridement with suture fixation of the proximal hamstring tendons to the ischium. Return to preinjury activities is expected in the majority of these cases, with low postoperative risks.
腘绳肌近端撕裂可能与异位骨化异常形成相关的慢性残疾有关。在这些情况下手术干预的作用尚未明确界定。
目的/假设：本研究的目的是描述因离心负荷损伤后腘绳肌近端骨化而导致慢性残疾的年轻运动员的手术治疗方法。假设是在手术切除腘绳肌近端创伤后异位骨化并同时将肌腱修复至坐骨后，预计在至少2年的随访中功能会有显著改善且术后并发症风险较低。
病例系列；证据等级，4级。
回顾了11例连续男性运动员的病例，这些运动员在与运动相关的撕裂后出现了与腘绳肌近端异位骨化相关的慢性残疾。在手术过程中，仔细切除骨化肿块，并清理肌腱并将其固定至坐骨。在至少2年的随访中，自我报告的结果被评为优秀、良好、中等或差。审查了手术报告和门诊记录。受伤前和最新随访时的活动水平用泰格纳量表进行分级。
受伤的中位年龄为17岁（范围13 - 25岁）。体育活动包括冰球、足球、田径和柔道。从受伤到手术的平均间隔时间为45个月。最小的骨化肿块为2×2×4厘米，最大的为3×4×9厘米。中位随访时间为4年（范围2 - 10年）。6例患者结果优秀，1例良好，4例中等；其中7例能够恢复到受伤前的活动水平（泰格纳评分，7 - 10分）。有2例患者在股后皮神经分布区域出现皮肤感觉丧失，但均未描述这对任何活动有明显干扰。在最新随访时，所有患者的双侧单腿跳测试结果对称，腘绳肌肌力均为5级。
离心负荷损伤后腘绳肌近端出现的异位骨化可能与严重的慢性残疾有关。通过手术切除骨化肿块并同时清理肌腱并将腘绳肌近端肌腱缝合固定至坐骨，这些病例可得到有效治疗。在大多数此类病例中，预计可恢复到受伤前的活动水平，且术后风险较低。
