Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Radiology and Nuclear Medicine, Schwarzwald-Baar Clinic, Klinikstrasse 11, 78052, Villingen-Schwenningen, Germany.
Arch Orthop Trauma Surg. 2020 Feb;140(2):145-153. doi: 10.1007/s00402-019-03228-1. Epub 2019 Jun 26.
Hip abductor tendinopathies are becoming increasingly recognized as clinically relevant disorders. However, knowledge about prevalence of abductor tendinopathies and associated disorders of adjacent hip articular and periarticular structures is limited. In this context, the relative diagnostic value of 1.5-T vs. 3.0-T MRI magnets has not been studied yet.
Pelvic MRI scans of 1000 hips from 500 consecutive unselected patients (341 in 3.0-T/159 in 1.5-T magnets, with standardized scanning protocols over the entire study period) were analysed for the detection of abductor tendinosis, calcifying tendinitis, partial or full-thickness tears of the M. gluteus medius (GMed) and/or -minimus (GMin) and trochanteric bursitis (TB). The occurrence of these lesions was correlated to the presence of muscle atrophy (MA) of GMed/GMin, hip joint effusion (JE) and osteoarthritis (OA).
Peritrochanteric lesions were observed with a prevalence of 31.4% of all patients (22.3% of all hips). TB occurred almost exclusively in the presence of GMed/GMin tendinopathies. Compared to overall prevalence, patients with MA displayed lesions of GMed/GMin or TB in 70%, patients, with OA in 30% and with JE in 23%. These lesions occurred significantly more often ipsilateral to MA and OA than contralateral (MA: 76.8% vs. 23.2%, p < 0.001; OA: 64.4% vs. 35.6%, p = 0.03; JE: 62.7% vs. 37.3%, p = 0.08). Significantly more tendon lesions, in particular specific radiological diagnoses like partial/full-thickness tears, were detected by 3.0-T MRI than by 1.5 T (p = 0.019).
Peritrochanteric lesions are a prevalent pathology that should specifically be looked for, preferably by 3.0-T MRI, independent of concomitant hip joint pathology.
髋关节外展肌肌腱病正日益被认为是具有临床相关性的疾病。然而，对于外展肌肌腱病及邻近髋关节关节和关节周围结构相关疾病的患病率，目前我们知之甚少。在这种情况下，1.5-T 与 3.0-T MRI 磁体的相对诊断价值尚未得到研究。
对 500 例连续未选择患者的 1000 个髋关节（3.0-T 组 341 例，1.5-T 组 159 例，整个研究期间采用标准化扫描方案）的骨盆 MRI 扫描进行分析，以检测外展肌肌腱病、钙化性肌腱炎、臀中肌（GMed）和/或-小肌（GMin）部分或全层撕裂以及转子滑囊炎（TB）。将这些病变的发生与 GMed/GMin 肌肉萎缩（MA）、髋关节积液（JE）和骨关节炎（OA）的存在相关联。
在所有患者中，经转子区病变的患病率为 31.4%（所有髋关节的 22.3%）。TB 几乎仅发生于 GMed/GMin 肌腱病时。与总体患病率相比，MA 患者的 GMed/GMin 或 TB 病变发生率为 70%，OA 患者为 30%，JE 患者为 23%。与 MA 和 OA 相反，这些病变在同侧的发生频率明显高于对侧（MA：76.8%对 23.2%，p<0.001；OA：64.4%对 35.6%，p=0.03；JE：62.7%对 37.3%，p=0.08）。3.0-T MRI 检测到的肌腱病变明显多于 1.5-T MRI，特别是部分/全层撕裂等特定影像学诊断（p=0.019）。
转子区周围病变是一种常见的病理学表现，应特别寻找，最好通过 3.0-T MRI 检查，与髋关节关节病变无关。
