Chandrasekaran Sivashankar, Darwish Nader, Vemula S Pavan, Lodhia Parth, Suarez-Ahedo Carlos, Domb Benjamin G
American Hip Institute, Westmont, IIlinois - USA.
Hinsdale Orthopaedics, Hinsdale, Illinois - USA.
Hip Int. 2017 Nov 21;27(6):567-572. doi: 10.5301/hipint.5000504. Epub 2017 Jun 6.
This study aims to present 3 patients' results after undergoing gluteus maximus and tensor fascia lata (TFL) transfer for chronic abductor tears unable to be repaired primarily.
3 patients were identified intraoperatively as having an abductor tear unable to be repaired primarily. The anterior 1/3 of the gluteus maximus and the posterior 1/3 of the TFL were mobilised and transferred to the greater trochanter in order to reproduce the normal force vector of the gluteus medius and minimus. Data was prospectively collected for changes in gait, abductor strength, and the following patient reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), visual analogue scale (VAS), and satisfaction.
The patients were female, 63-75 years old, with BMIs of 23-28. All patients had follow-up at mean 2.1 years (1.25-2.5) with positive Trendelenburg signs preoperatively; 2 patients normalised postoperatively. For 2 patients, abductor strength improved by 2 grades postoperatively; the other patient maintained grade four. 2 patients' PROs all improved; the other patient's PROs all improved except mHHS. Postoperative VAS scores were 0, 0, 1. 2 patients reported maximum satisfaction.
This case series suggests that gluteus maximus and TFL transfer for irreparable abductor deficiency may be effective for pain relief, improving abductor strength, and reconstructing abductor function. Although this is a small series, it is to our knowledge the first report of clinical outcomes of this procedure.
本研究旨在呈现3例因慢性外展肌撕裂无法一期修复而接受臀大肌和阔筋膜张肌(TFL)转移术后的患者结果。
术中确定3例患者存在无法一期修复的外展肌撕裂。将臀大肌前1/3和阔筋膜张肌后1/3游离并转移至大转子,以重现臀中肌和臀小肌的正常力向量。前瞻性收集患者步态、外展肌力量变化以及以下患者报告结局(PROs)的数据:改良Harris髋关节评分(mHHS)、非关节炎髋关节评分(NAHS)、髋关节结局评分 - 运动特定子量表(HOS - SSS)、髋关节结局评分 - 日常生活活动(HOS - ADL)、视觉模拟量表(VAS)和满意度。
患者均为女性,年龄63 - 75岁,体重指数(BMI)为23 - 28。所有患者平均随访2.1年(1.25 - 2.5年),术前均有阳性Trendelenburg征;2例术后恢复正常。2例患者术后外展肌力量提高2级;另1例患者维持在4级。2例患者的PROs均有改善;另1例患者除mHHS外PROs均有改善。术后VAS评分为0、0、1。2例患者报告最大满意度。
本病例系列表明,对于无法修复的外展肌缺损,臀大肌和阔筋膜张肌转移术可能对缓解疼痛、增强外展肌力量和重建外展肌功能有效。尽管这是一个小样本系列,但据我们所知,这是该手术临床结局的首次报告。