Mayo Clinic Arizona, Phoenix, Arizona.
American Hip Institute, Hinsdale, Illinois.
Arthroscopy. 2018 Aug;34(8):2389-2397. doi: 10.1016/j.arthro.2018.03.039. Epub 2018 Jul 7.
The purpose of this study is to identify radiographic risk factors (RRFs) and radiographic signs of abductor tendon tears.
Between April 2008 and October 2015, patients with intraoperative diagnosis of partial- or full-thickness abductor tear noted at the time of open or endoscopic treatment were included in this study. Exclusion criteria included lack of preoperative standard supine pelvic radiograph, lack of preoperative magnetic resonance imaging (MRI), or abductor tear not present at the time of operative intervention. Patients were matched by age ±5 years, gender, and body mass index ±5 with patients with no abductor pathology by clinical exam and MRI. A standardized supine anterior-posterior pelvis radiograph was performed on all patients. The radiographs were evaluated for RRF (pelvic width, body weight moment arm, abductor moment arm, abductor angle, pelvic height) and signs of abductor tendon pathology (greater trochanteric enthesophyte). Femoral version was measured on MRI when images were available. Statistical analysis was performed and included bivariate and multivariate analyses.
There were 152 patients with abductor tears identified at the time of surgery out of 2,838 eligible patients matched with 125 patients without abductor tendon pathology. The study institution was unable to perform a 1:1 match because of the advanced age of the abductor tendon group, which led to a greater age in the abductor group (n = 58) versus the control group (n = 54; P = .01. In abductor group the average age was 58, and 137 of 152 (90%) patients were female; in the control group the average age was 54, with 111 of 125 (89%) patients being female. Abductor tear patients were treated with surgical repair. The RRFs found with bivariate analysis were an increased pelvic width (14.8 cm for abductor tears vs 14.3 cm for control; P < .001), body weight moment arm (11.1 cm vs 10.9 cm; P < .001), and abductor moment arm (7.8 cm vs 7.6 cm; P < .001); decreased femoral anteversion (7.6° vs 10.6°; P = .045); and enthesophyte presence (41% vs 3%; P < .001). Multivariate regression analysis of all variables showed that teardrop distance and enthesophyte presence were the 2 variables most predictive of abductor tears, and other variables did not significantly increase or decrease the likelihood of tear when these 2 variables were considered. The presence of an enthesophyte on the greater trochanter was notable for an odds ratio of 20.7 of having an abductor tear.
Patients with abductor tears have a wider pelvis, longer abductor moment arm, and longer body weight moment arm and have greater trochanteric enthesophyte as noted on nearly half of patients with an abductor tear. Presence of an enthesophyte was noted to have an odds ratio of 20.7 and a positive predictive value of 94% for having an abductor tendon tear. The 2 variables predictive of abductor tendon tear when controlling for all variables were enthesophyte presence and teardrop distance, with no other variables significantly increasing or decreasing the likelihood of tear when these 2 variables were considered.
Level III, retrospective comparative study.
本研究旨在确定导致髋外展肌腱撕裂的影像学危险因素（RRF）和影像学征象。
2008 年 4 月至 2015 年 10 月期间，对接受开放或内镜治疗的术中诊断为部分或全层髋外展肌撕裂的患者进行了研究。排除标准包括术前缺乏标准仰卧骨盆 X 线片、术前缺乏磁共振成像（MRI）或手术干预时不存在髋外展肌撕裂。通过年龄±5 岁、性别和体质量指数±5 与临床检查和 MRI 无髋外展病变的患者进行匹配。所有患者均行标准仰卧骨盆前后位 X 线片检查。评估 RRF（骨盆宽度、体重力臂、髋外展力臂、髋外展角、骨盆高度）和髋外展肌腱病变征象（大转子附着点骨赘）。当有 MRI 图像时，测量股骨前倾角。进行了包括双变量和多变量分析的统计学分析。
在 2838 例符合条件的患者中，有 152 例在手术时发现有髋外展肌撕裂，与 125 例无髋外展肌腱病变的患者相匹配。由于髋外展肌腱组患者年龄较大，本研究机构无法进行 1:1 匹配，导致髋外展组（n=58）的平均年龄大于对照组（n=54；P=.01）。在髋外展组中，平均年龄为 58 岁，152 例患者中有 137 例（90%）为女性；在对照组中，平均年龄为 54 岁，125 例患者中有 111 例（89%）为女性。髋外展肌撕裂患者接受了手术修复。双变量分析发现的 RRF 包括骨盆宽度增加（髋外展撕裂患者为 14.8cm，对照组为 14.3cm；P<0.001）、体重力臂增加（髋外展撕裂患者为 11.1cm，对照组为 10.9cm；P<0.001）和髋外展力臂增加（髋外展撕裂患者为 7.8cm，对照组为 7.6cm；P<0.001）；股骨前倾角减小（髋外展撕裂患者为 7.6°，对照组为 10.6°；P=0.045）；附着点骨赘存在（41%比 3%；P<0.001）。所有变量的多变量回归分析显示，撕脱距离和附着点骨赘的存在是最能预测髋外展撕裂的 2 个变量，当考虑这 2 个变量时，其他变量并不能显著增加或降低撕裂的可能性。大转子附着点骨赘的存在具有 20.7 的髋外展撕裂的优势比。
髋外展肌撕裂患者的骨盆更宽，髋外展力臂和体重力臂更长，并且近一半的髋外展肌撕裂患者的大转子附着点有附着点骨赘。附着点骨赘的存在对髋外展肌腱撕裂的优势比为 20.7，阳性预测值为 94%。在控制所有变量的情况下，对髋外展肌腱撕裂具有预测作用的是附着点骨赘和撕脱距离，当考虑这 2 个变量时，没有其他变量显著增加或降低撕裂的可能性。
