Schröder J H, Geßlein M, Schütz M, Perka C, Krüger D
Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Klinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland.
Orthopade. 2018 Mar;47(3):238-245. doi: 10.1007/s00132-017-3524-1.
Operative refixation is a new therapeutic option in cases of failed conservative treatment for trochanteric pain syndrome (TPS) and lesions of the hip abductors in magnetic resonance imaging (MRI).
Evaluation of the clinical and radiological results after open gluteus medius and minimus tendon reconstruction with a double-row technique was carried out.
Patients with failed conservative treatment for TPS and confirmed lesions of the hip abductors in MRI were treated by open hip abductor tendon reconstruction with a double-row technique. The patients were evaluated preoperatively and postoperatively (minimum follow-up 12 months) using the modified Harris hip score (mHHS) and a subjective score (subjective hip value, SHV). Preoperative and postoperative MRI evaluation included measurement of hip abductor muscle diameter and cross-sectional area as well as fatty degeneration.
In this study 12 consecutive cases of open reconstruction of the hip abductor tendons were included. There was a significant improvement in the mHHS. In one case the patient showed an atraumatic rupture in the proximal anchor row. The MRI showed a significant improvement in muscle diameter and cross-sectional area for the gluteus medius muscle of the affected and the contralateral side, while the degree of fatty degeneration did not improve. The fatty degeneration showed a significant correlation with the postoperative results in the mHHS and the SHV.
Operative reconstruction of lesions in the hip abductor tendons is a therapy option with significant improvement of patient satisfaction and functional scores as well as muscle diameter and cross-sectional area for the gluteus medius. The degree of fatty degeneration and possible differential diagnoses need to be taken into consideration.
对于转子疼痛综合征（TPS）保守治疗失败以及磁共振成像（MRI）显示髋外展肌损伤的病例，手术重新固定是一种新的治疗选择。
对采用双排技术进行开放性臀中肌和臀小肌腱重建后的临床和影像学结果进行评估。
对TPS保守治疗失败且MRI证实存在髋外展肌损伤的患者，采用双排技术进行开放性髋外展肌腱重建。术前和术后（最短随访12个月）使用改良Harris髋关节评分（mHHS）和主观评分（主观髋关节值，SHV）对患者进行评估。术前和术后的MRI评估包括测量髋外展肌直径、横截面积以及脂肪变性情况。
本研究纳入了12例连续的髋外展肌腱开放性重建病例。mHHS有显著改善。1例患者近端锚钉排出现无创伤性断裂。MRI显示患侧和对侧臀中肌的肌肉直径和横截面积有显著改善，而脂肪变性程度未改善。脂肪变性与mHHS和SHV的术后结果有显著相关性。
髋外展肌腱损伤的手术重建是一种治疗选择，可显著提高患者满意度和功能评分，以及臀中肌的肌肉直径和横截面积。需要考虑脂肪变性程度和可能的鉴别诊断。
