Sineoky A D, Pliev D G, Abolin A B, Mikhailova P M, Guatsaev M S, Shubnyakov M I, Mikhailov K S
Vreden Russian Research Institute for Traumatology and Orthopaedics, St. Petersburg, Russia.
Elisavetinskaya hospital, St. Petersburg, Russia.
Khirurgiia (Mosk). 2019(7):96-104. doi: 10.17116/hirurgia201907196.
Injury of gluteus medius muscle is a serious often complication after hip replacement surgery followed by pain, claudication and significant deterioration of the quality of life. Prevention of intraoperative injury of this muscle is especially relevant in young patients. Normal function of this muscle provides rapid rehabilitation and early postoperative recovery. However, hip replacement surgery through Hardinge's direct lateral approach is accompanied by fatty degeneration of gluteus medius muscle in 12-20% of cases. Moreover, two or more redo procedures lead to fatty degeneration of almost 70% of anterior and 40% of central muscular segment. Currently, there are many methods of surgical treatment of this complication including transosseous muscle fixation, endoscopic procedures, repair using Achilles tendon, gluteus maximus muscle, lateral head of quadriceps muscle and allografts. However, various publications devoted to this problem have certain disadvantages including short follow-up period, small sample size and often unsatisfactory outcomes. Therefore, the question of surgical repair of hip abductor function remains open.
臀中肌损伤是髋关节置换术后常见的严重并发症，会导致疼痛、跛行以及生活质量显著下降。对于年轻患者而言，预防该肌肉的术中损伤尤为重要。该肌肉的正常功能有助于快速康复和术后早期恢复。然而，采用哈丁格直接外侧入路进行髋关节置换手术时，12%至20%的病例会出现臀中肌脂肪变性。此外，进行两次或更多次翻修手术会导致近70%的前侧肌肉段和40%的中央肌肉段出现脂肪变性。目前，针对这一并发症有多种手术治疗方法，包括经骨肌肉固定术、内镜手术、使用跟腱、臀大肌、股四头肌外侧头和同种异体移植物进行修复。然而，关于这个问题的各种出版物存在一定的缺点，包括随访期短、样本量小以及结果往往不尽人意。因此，髋关节外展肌功能的手术修复问题仍然悬而未决。
