Lerch S, Stark D, Rühmann O
Klinikum Agnes Karll Laatzen, Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Region Hannover, Hildesheimer Straße 158, 30880, Laatzen, Deutschland.
Oper Orthop Traumatol. 2018 Apr;30(2):80-86. doi: 10.1007/s00064-018-0536-x. Epub 2018 Feb 22.
Snapping of the iliotibial band over the greater trochanter should be eliminated by reducing tension via lengthening, release, and incision of the iliotibial band.
Positive clinical examination and painful snapping of the iliotibial band over the greater trochanter, despite extensive conservative treatments, for over 6 months.
Weakness of the abductor muscles with positive Trendelenburg sign.
Direct approach to the iliotibial tract. The snapping of the tract over the greater trochanter can be provoked and observed in situ via internal rotation and adduction of the hip. Lengthening of the iliotibial band is performed with a tongue-shape flap technique ("Griffelschachtelplastik") directly over the greater trochanter. This leads to simultaneous release and incision over the greater trochanter. Hereafter, no snapping of the tract should be observed upon motion analysis.
Pain-adapted mobilization with full weightbearing, no active abduction against resistance, and no adduction over and exceeding the 0‑degree level for 6 weeks.
The snapping of the iliotibial band could be eliminated in all cases. Apart from 2 patients with previous surgery who still complain of unimproved pain, improvement of symptoms with consequent subjective satisfaction with the outcome of surgery was reported in all cases.
通过延长、松解和切开髂胫束来减轻张力，从而消除髂胫束在大转子处的弹响。
尽管进行了6个月以上广泛的保守治疗，但临床检查阳性且髂胫束在大转子处有疼痛性弹响。
外展肌无力且Trendelenburg征阳性。
直接入路至髂胫束。通过髋关节内旋和内收可在原位诱发并观察到髂胫束在大转子处的弹响。在大转子正上方采用舌形皮瓣技术（“Griffelschachtelplastik”）延长髂胫束。这会导致在大转子处同时进行松解和切开。此后，在运动分析时不应观察到髂胫束的弹响。
根据疼痛情况进行适应性活动，完全负重，6周内禁止主动抗阻外展，禁止内收超过0度水平。
所有病例中髂胫束的弹响均得以消除。除2例曾接受手术的患者仍抱怨疼痛未改善外，所有病例均报告症状改善，患者对手术结果主观满意。
