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髋关节外展肌撕裂的内镜修复:两年随访结果

Endoscopic repair of hip abductor tears: outcomes with two-year follow-up.

作者信息

Byrd J W Thomas, Jones Kay S

机构信息

Nashville Sports Medicine Foundation, 2011 Church Street, Suite 100, Nashville, TN 37203, USA.

出版信息

J Hip Preserv Surg. 2017 Jan 9;4(1):80-84. doi: 10.1093/jhps/hnw047. eCollection 2017 Jan.

Abstract

Abductor lesions are increasingly recognized as a source of recalcitrant laterally based hip pain and dysfunction. There is a growing body of evidence that many of these may be amenable to endoscopic repair. To report the demographic data and outcomes of endoscopic hip abductor repair. Twelve patients underwent endoscopic abductor repair with 2-year follow-up. These patients were prospectively assessed with modified Harris hip and iHOT scores. The indications for surgery were clinical and MRI findings of symptomatic abductor tears that had failed conservative treatment. All patients underwent concomitant or prior arthroscopy of the joint. Repair was performed with suture anchors using an iliotibial band-sparing endoscopic technique; followed by a 4-month structured rehabilitation protocol. Follow-up was obtained on all patients at 24 months. The average age was 56 years (range 39-77 years). These were all females. All demonstrated improved modified Harris hip scores, averaging 43 points (preop 42; postop 85). Eleven of 12 (92%) demonstrated improved iHOT scores, averaging 52 points (preop 21; postop 73). Ten patients had accompanying intra-articular pathology including 10 labral tears, chondral lesions, 6 synovitis and 1 pincer impingement. There were no complications, and none underwent further surgery. Abductor tears of the hip can be clinically relevant and respond well to endoscopic repair. This tends to be a disorder of older females who present with severe disability, reflected by low preoperative modified Harris hip scores, and demonstrate significant, although incomplete, improvement.

摘要

外展肌损伤越来越被认为是顽固性髋部外侧疼痛和功能障碍的一个原因。越来越多的证据表明,其中许多损伤可能适合内镜修复。报告内镜下髋外展肌修复的人口统计学数据和结果。12例患者接受了内镜下外展肌修复,并进行了2年的随访。这些患者采用改良Harris髋关节评分和iHOT评分进行前瞻性评估。手术指征为有症状的外展肌撕裂经保守治疗无效的临床和MRI表现。所有患者均同时或先前接受过关节镜检查。使用保留髂胫束的内镜技术用缝合锚钉进行修复;随后是为期4个月的结构化康复方案。对所有患者进行了24个月的随访。平均年龄为56岁(范围39 - 77岁)。这些患者均为女性。所有患者改良Harris髋关节评分均有改善,平均提高43分(术前42分;术后85分)。12例中有11例(92%)iHOT评分改善,平均提高52分(术前21分;术后73分)。10例患者伴有关节内病变,包括10例盂唇撕裂、软骨损伤、6例滑膜炎和1例钳夹撞击征。无并发症发生,也无人接受进一步手术。髋部外展肌撕裂在临床上可能具有相关性,并且对内镜修复反应良好。这往往是一种老年女性的疾病,她们表现出严重的残疾,术前改良Harris髋关节评分较低,尽管改善不完全,但仍有显著改善。

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