Kaya Mitsunori
Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan.
PLoS One. 2018 Jan 11;13(1):e0191091. doi: 10.1371/journal.pone.0191091. eCollection 2018.
For patients who have anterior hip pain evaluated by Patrick's test and tenderness at Scarpa's triangle, we perform periarticular debridement based on the hypothesis that extra-articular pathologies are responsible for the hip pain. The purpose of this study was to categorize the endoscopic extra-articular findings and to evaluate the clinical significance of periarticular pathologies in anterior hip pain.
Arthroscopic findings of 77 patients who underwent periarthritic debridement were evaluated. As extra-articular pathologies, injuries of the direct head and reflective head of the rectus femoris muscle were evaluated. A thin layer of fat tissue normally exists on the anterior inferior iliac spine (AIIS), the attachment site of the direct head of the rectus femoris muscle. The macroscopic appearance of the fat pad on the AIIS was categorized as normal, blood vessel-rich adipose tissue or adipose tissue with fibrosis or scar formation and histologically confirmed. Adhesion of gluteal muscles to the joint capsule was also evaluated.
Of the 77 patients, 75 had rupture of the direct head of the rectus femoris. In contrast, rupture of the reflective head was extremely rare. Seven patients had a normal fat pad on the AIIS, 11 had blood vessel-rich adipose tissue and 55 had adipose tissue with fibrosis. Fat tissue was completely replaced by fibrous scar tissue in another 4 patients. In 64 patients, adhesion between the anterior joint capsule and gluteus muscles was marked. Groin pain disappeared soon after the operation even when labral tears were not repaired and all patients returned to daily life and sports activities within 2 weeks after operation.
Rectus femoris tendinosis, fibrosis of the AIIS fat pad, and adhesion of gluteal and rectus femoris muscles are common extra-articular pathologies in patients with anterior hip pain. Management of only these lesions induces rapid relief of anterior hip pain even in the absence of labral tear repair. My observations suggest that it is desirable to be aware of the presence of periarticular pathologies as a cause of groin pain.
对于通过帕特里克试验评估有髋关节前部疼痛且斯卡帕三角区有压痛的患者，我们基于关节外病变是髋关节疼痛病因的假设进行关节周围清创术。本研究的目的是对关节镜下关节外发现进行分类，并评估关节周围病变在髋关节前部疼痛中的临床意义。
对77例行关节周围清创术患者的关节镜检查结果进行评估。作为关节外病变，评估股直肌直接头和反折头的损伤情况。在股直肌直接头的附着点即髂前下棘（AIIS）通常存在一层薄脂肪组织。将AIIS上脂肪垫的宏观外观分类为正常、富含血管的脂肪组织或有纤维化或瘢痕形成的脂肪组织，并进行组织学确认。还评估了臀肌与关节囊的粘连情况。
77例患者中，75例股直肌直接头断裂。相比之下，反折头断裂极为罕见。7例患者AIIS上的脂肪垫正常，11例有富含血管的脂肪组织，55例有纤维化的脂肪组织。另外4例患者的脂肪组织完全被纤维瘢痕组织替代。64例患者中，前关节囊与臀肌之间有明显粘连。即使未修复盂唇撕裂，术后腹股沟疼痛也很快消失，所有患者术后2周内恢复日常生活和体育活动。
股直肌肌腱病、AIIS脂肪垫纤维化以及臀肌与股直肌粘连是髋关节前部疼痛患者常见的关节外病变。仅处理这些病变即使在未修复盂唇撕裂的情况下也能迅速缓解髋关节前部疼痛。我的观察结果表明，应意识到关节周围病变是腹股沟疼痛的一个病因。
