Mayo Clinic Arizona, Phoenix, Arizona, U.S.A.
American Hip Institute, Westmont, Illinois, U.S.A.
Arthroscopy. 2018 Jun;34(6):1841-1850. doi: 10.1016/j.arthro.2018.01.027. Epub 2018 Apr 10.
The purpose of this study was to evaluate the greater than 2-year patient-reported outcomes (PROs) and patient satisfaction of patients who were treated with hip arthroscopy for snapping iliopsoas tendons that were painful with concomitant acetabular dysplasia and who underwent iliopsoas lengthening for symptomatic iliopsoas tendon snapping with concomitant capsular plication and treatment of hip impingement. Secondary measures included observation of the change in the Tönnis grade at greater than 2 years' follow-up.
Between July 2009 and December 2011, data on patients with a lateral center-edge angle (LCEA) of less than 25° (range, 19°-24°) who underwent hip arthroscopy with central-compartment iliopsoas fractional lengthening and capsular plication were prospectively collected and retrospectively reviewed. Interportal capsular repair was performed using between 2 and 5 simple sutures. Patients also underwent procedures to treat hip impingement pathology. All patients had preoperative and minimum 2-year postoperative PRO measures: modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living subscale, Hip Outcome Score-Sports-Specific subscale, and Non-arthritic Hip Score. The visual analog scale score and patient satisfaction with surgery (from 0 to 10) were also collected. Radiographs were analyzed preoperatively and at latest follow-up to assess progression of the Tönnis grade.
We analyzed 32 patients who met the inclusion criteria (30 female and 2 male patients; mean age, 25 years). The mean LCEA and anterior center-edge angle were 21.6° and 25.5°, respectively. Four patients required revision arthroscopy for labral retears. Among the 28 patients who did not undergo revision surgery, the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living subscale, Hip Outcome Score-Sports-Specific subscale, and Non-arthritic Hip Score improved from 68.7 to 83.5, from 64.9 to 86.6, from 71.6 to 86.7, and from 52.6 to 75.8, respectively (P < .001). The visual analog scale score improved from 5.6 preoperatively to 1.9 at latest follow-up (P < .001). The mean patient satisfaction rating was 8.0. There was no radiographic progression of the Tönnis grade at final follow-up.
This study showed that patients with an LCEA of less than 25° and associated painful iliopsoas snapping can be treated by addressing concomitant pathology and performing central-compartment fractional lengthening of the iliopsoas tendon with concomitant capsular plication and have high satisfaction, improvement in PROs, and improved pain scores, without significant progression of osteoarthritis.
Level IV, case series.
本研究旨在评估接受髋关节镜检查治疗伴有髋臼发育不良的疼痛性髂腰肌弹响患者，并对同时伴有髂腰肌肌腱弹响和关节囊紧缩的髂腰肌延长术患者进行超过 2 年的患者报告结局（PRO）和患者满意度评估。次要测量指标包括在随访超过 2 年时观察 Tönnis 分级的变化。
2009 年 7 月至 2011 年 12 月，前瞻性收集并回顾性分析了外侧中心边缘角（LCEA）<25°（范围 19°-24°）的患者行髋关节镜检查中央隔室髂腰肌部分延长和关节囊紧缩的数据。采用 2 至 5 个简单缝线进行跨端口关节囊修复。患者还接受了治疗髋关节撞击病理的手术。所有患者均接受术前和至少 2 年的术后 PRO 测量：改良 Harris 髋关节评分、髋关节结果评分-日常生活活动量表、髋关节结果评分-运动特定量表和非关节炎髋关节评分。还收集了视觉模拟评分（VAS）和手术满意度（0-10 分）。术前和末次随访时拍摄 X 线片评估 Tönnis 分级的进展情况。
我们分析了 32 名符合纳入标准的患者（30 名女性和 2 名男性；平均年龄 25 岁）。平均 LCEA 和前中心边缘角分别为 21.6°和 25.5°。4 名患者因盂唇撕裂行关节镜翻修术。在未行翻修手术的 28 名患者中，改良 Harris 髋关节评分、髋关节结果评分-日常生活活动量表、髋关节结果评分-运动特定量表和非关节炎髋关节评分分别从 68.7 提高到 83.5、从 64.9 提高到 86.6、从 71.6 提高到 86.7 和从 52.6 提高到 75.8（P<.001）。VAS 评分从术前的 5.6 分改善至末次随访时的 1.9 分（P<.001）。平均患者满意度评分为 8.0。最终随访时，Tönnis 分级无影像学进展。
本研究表明，对于 LCEA<25°且伴有疼痛性髂腰肌弹响的患者，可以通过治疗伴发的病理情况和行中央隔室髂腰肌部分延长术并同时进行关节囊紧缩来治疗，这些患者满意度高，PRO 改善，疼痛评分降低，且无明显骨关节炎进展。
IV 级，病例系列研究。
