Roos M M, Bakker W J, Goedhart E A, Verleisdonk E J M M, Clevers G J, Voorbrood C E H, Sanders F B M, Naafs D B, Burgmans J P J
Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands.
Sports Medical Centre Royal Netherlands Football Association/FIFA Medical Centre of Excellence, Zeist, The Netherlands.
Hernia. 2018 Jun;22(3):517-524. doi: 10.1007/s10029-018-1741-0. Epub 2018 Jan 30.
Inguinal disruption, a common condition in athletes, is a diagnostic and therapeutic challenge. The aim of this study was to evaluate the effect of endoscopic totally extraperitoneal (TEP) repair in athletes with inguinal disruption, selected through a multidisciplinary, systematic work-up.
An observational, prospective cohort study was conducted in 32 athletes with inguinal disruption. Athletes were assessed by a sports medicine physician, radiologist and hernia surgeon and underwent subsequent endoscopic TEP repair with placement of polypropylene mesh. The primary outcome was pain reduction during exercise on the numeric rating scale (NRS) 3 months postoperatively. Secondary outcomes were sports resumption, physical functioning and long-term pain intensity. Patients were assessed preoperatively, 3 months postoperatively and after a median follow-up of 19 months.
Follow-up was completed in 30 patients (94%). The median pain score decreased from 8 [interquartile range (IQR) 7-8] preoperatively to 2 (IQR 0-5) 3 months postoperatively (p < 0.001). At long-term follow-up, the median pain score was 0 (IQR 0-3) (p < 0.001). At 3 months, 60% of patients were able to complete a full training and match. The median intensity of sport was 50% (IQR 20-70) preoperatively, 95% (IQR 70-100) 3 months postoperatively (p < 0.001), and 100% (IQR 90-100) at long-term follow-up (p < 0.001). The median frequency of sport was 4 (IQR 3-5) times per week before development of symptoms and 3 (IQR 3-4) times per week 3 months postoperatively (p = 0.025). Three months postoperatively, improvement was shown on all physical functioning subscales.
Athletes with inguinal disruption, selected through a multidisciplinary, systematic work-up, benefit from TEP repair.
腹股沟损伤在运动员中较为常见，是诊断和治疗方面的一个挑战。本研究的目的是评估通过多学科系统检查筛选出的腹股沟损伤运动员接受内镜下完全腹膜外（TEP）修补术的效果。
对32例腹股沟损伤的运动员进行了一项观察性前瞻性队列研究。由运动医学医生、放射科医生和疝外科医生对运动员进行评估，随后进行内镜下TEP修补术并放置聚丙烯补片。主要结局是术后3个月时运动期间数字评分量表（NRS）上的疼痛减轻情况。次要结局包括恢复运动、身体功能和长期疼痛强度。在术前、术后3个月以及中位随访19个月后对患者进行评估。
30例患者（94%）完成了随访。中位疼痛评分从术前的8分[四分位间距（IQR）7 - 8]降至术后3个月的2分（IQR 0 - 5）（p < 0.001）。在长期随访中，中位疼痛评分为0分（IQR 0 - 3）（p < 0.001）。术后3个月时，60%的患者能够完成完整的训练和比赛。术前运动强度中位数为50%（IQR 20 - 70），术后3个月为95%（IQR 70 - 100）（p < 0.001），长期随访时为100%（IQR 90 - 100）（p < 0.001）。症状出现前运动频率中位数为每周4次（IQR 3 - 5），术后3个月为每周3次（IQR 3 - 4）（p = 0.025）。术后3个月，所有身体功能子量表均显示有改善。
通过多学科系统检查筛选出的腹股沟损伤运动员可从TEP修补术中获益。
