Wilson Mark D, Keene James S
1. Wilson Orthopaedics and Sports Medicine, 216 West Union Street, Suite a, Minden, LA 71055, USA.
2. Division of Sports Medicine, Department of Orthopedic Surgery and Rehabilitation, 1685 Highland Avenue, Madison, WI 53705-2281, USA and; 3. University of Wisconsin, Madison, WI, USA.
J Hip Preserv Surg. 2016 Feb 26;3(2):146-53. doi: 10.1093/jhps/hnw006. eCollection 2016 Jul.
Ischiofemoral impingement (IFI) is an often unrecognized cause of hip pain caused by abnormal contact between the lesser trochanter and the ischium. To date, surgical treatment for those whose pain is not relieved by activity modification and steroid injections has not been defined. This study describes our imaging protocol and reports the results of arthroscopic, lesser trochanteric resections that were performed to treat this condition. Seven patients with symptomatic, MRI-documented IFI had ultrasound injections of ropivicaine and steroid into their ischiofemoral space. The injections provided complete but only transient relief of their groin and buttock pain and thus, all seven ultimately had an arthroscopic resection of their lesser trochanter. All hips were evaluated preoperatively and at 3, 6 and 12 months postoperatively with Byrd's modified Harris hip scoring system. Average age of the seven patients was 46 years and there were five females and one male. Preoperative scores averaged 43 points. After surgery, all patients used crutches for 4-6 weeks, and had 6-week scores that averaged 58 points. The patients and their scores continued to improve and at 6 and 12 months, their scores averaged 86 and 91 points, and none had chronic hip flexor weakness or recurrence of their hip pain or snapping. Arthroscopic iliopsoas tenotomies in combination with a resection of the lesser trochanter will provide complete relief of the painful snapping, groin and buttock pain caused by ischiofemoral impingement.
坐骨股骨撞击症（IFI）是一种常未被识别的髋部疼痛原因，由小转子与坐骨之间的异常接触引起。迄今为止，对于那些通过改变活动方式和注射类固醇仍无法缓解疼痛的患者，手术治疗方法尚未明确。本研究描述了我们的成像方案，并报告了为治疗该病症而进行的关节镜下小转子切除术的结果。7例有症状且MRI证实为IFI的患者，在坐骨股骨间隙接受了罗哌卡因和类固醇的超声引导注射。注射仅提供了腹股沟和臀部疼痛的完全但短暂缓解，因此，所有7例患者最终均接受了关节镜下小转子切除术。所有髋关节均在术前以及术后3个月、6个月和12个月采用伯德改良的Harris髋关节评分系统进行评估。7例患者的平均年龄为46岁，其中5例女性，1例男性。术前平均评分为43分。术后，所有患者使用拐杖4至6周，6周时平均评分为58分。患者及其评分持续改善，在6个月和12个月时，平均评分分别为86分和91分，且无一例出现慢性髋部屈肌无力或髋部疼痛或弹响复发。关节镜下髂腰肌松解术联合小转子切除术可完全缓解坐骨股骨撞击症引起的疼痛性弹响、腹股沟和臀部疼痛。
