Harvard Combined Orthopaedic Surgery Residency Program, Boston, Massachusetts.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Bone Joint Surg Am. 2019 Feb 20;101(4):361-368. doi: 10.2106/JBJS.17.01670.
The objective of this study was to analyze the literature regarding the diagnosis, pathogenesis, and prevalence of gluteal fibrosis (GF) and the outcomes of treatment.
We searched PubMed, Embase, and Cochrane literature databases, from database inception to December 15, 2016. We used the following search terms including variants: "contracture," "fibrosis," "injections," "injections, adverse reactions,' "gluteal," and "hip." All titles and abstracts of potentially relevant studies were scanned to determine whether the subject matter was potentially related to GF, using predefined inclusion and exclusion criteria. If the abstract had subject matter involving GF, the paper was selected for review if full text was available. Only papers including ≥10 subjects who underwent surgical treatment were included in the systematic analysis. Data abstracted included the number of patients, patient age and sex, the type of surgical treatment, the method of outcome measurement, and outcomes and complications.
The literature search yielded 2,512 titles. Of these, 82 had a focus on GF, with 50 papers meeting the inclusion criteria. Of the 50 papers reviewed, 18 addressed surgical outcomes. The surgical techniques in these papers included open, minimally invasive, and arthroscopic release and radiofrequency ablation. Of 3,733 operatively treated patients in 6 reports who were evaluated on the basis of the criteria of Liu et al., 83% were found to have excellent results. Few papers focused on the incidence, prevalence, and natural history of GF, precluding quantitative synthesis of the evidence in these domains.
This study provided a systematic review of surgical outcomes and a summary of what has been reported on the prevalence, diagnosis, prognosis, and pathogenesis of GF. Although GF has been reported throughout the world, it requires further study to determine the exact etiology, pathogenesis, and appropriate treatment. Surgical outcomes appear satisfactory.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在分析臀肌纤维化（GF）的诊断、发病机制、流行率以及治疗效果。
我们检索了 PubMed、Embase 和 Cochrane 文献数据库，检索时间截至 2016 年 12 月 15 日。我们使用了以下检索词及变体：“挛缩”、“纤维化”、“注射”、“注射，不良反应”、“臀肌”和“髋部”。所有可能相关研究的标题和摘要均进行了扫描，以确定其主题是否与 GF 有关，使用了预先设定的纳入和排除标准。如果摘要涉及 GF，则如果有全文可获取，则选择该文献进行综述。仅纳入了包含≥10 例接受手术治疗患者的研究进行系统分析。提取的数据包括患者数量、患者年龄和性别、手术治疗类型、结果测量方法以及结果和并发症。
文献检索共得到 2512 个标题。其中 82 个标题与 GF 相关，50 篇文献符合纳入标准。在这 50 篇综述中，有 18 篇涉及手术结果。这些文献中的手术技术包括开放式、微创式和关节镜下松解术以及射频消融术。在 6 篇报道中，根据 Liu 等人的标准评估了 3733 例接受手术治疗的患者，其中 83%的患者结果为优秀。很少有文献关注 GF 的发生率、流行率和自然病史，因此无法对这些领域的证据进行定量综合。
本研究对手术结果进行了系统评价，并对 GF 的流行率、诊断、预后和发病机制的已有报道进行了总结。尽管 GF 已在世界各地报道，但仍需要进一步研究以确定其确切病因、发病机制和适当的治疗方法。手术结果似乎令人满意。
治疗性 IV 级。详见作者指南，以获取完整的证据等级描述。
