Department of Orthopaedic Surgery, Sant'Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa, 1035, 00189, Rome, Italy.
Int Orthop. 2020 Feb;44(2):275-282. doi: 10.1007/s00264-019-04468-x. Epub 2019 Dec 18.
The aim of this prospective study was to perform a clinical and radiologic evaluation of patients undergoing total hip arthroplasty (THA). The hypothesis is that there is a correlation between the pre-operative degeneration state of the gluteal muscle-tendinous unit and the clinical outcome in terms of functional recovery.
Fifty-five patients have met inclusion criteria. All patients included in the sample were subjected to clinical evaluation. The ultrasound examination of the patients of the study was conducted and the following parameters were assessed: Thickness in mm of the gluteus medius tendon; Quality of the gluteus medius tendon; and Trophy and muscular composition.
The degree of degeneration of the pre-operative tendon shows a negative statistical correlation with all the pre- and post-operative clinical scales, but presents statistical significance (p < 0.05) only with the post-operative Harris, the post-operative Oxford, the Harris and HOOS-modified post-operative, lameness, and Trendelenburg; it correlates positively with the quality of the macroscopic tendon detected intra-operatively, the degree of the pre-operative contralateral tendon, and the operated and contralateral pre-operative muscle (p < 0.05). The degree of fatty degeneration of the pre-operatively operated muscle correlates negatively (p < 0.05) with all pre- and post-operative clinical scales except for the pre-operative WOMAC and HOOS modified, with the lameness and the Trendelenburg sign; it correlates positively (p < 0.05) with age, the quality of the macroscopic tendon detected intra-operatively, degree of tendon degeneration, fatty infiltration of the contralateral pre- and post-operative muscle and of the post-operative operated muscle.
Tendon degeneration and fatty infiltration of the gluteus medius muscle appeared to be determinants of the post-operative persistence of lameness and Trendelenburg sign positivity in patients undergoing hip arthroplasty.
本前瞻性研究旨在对接受全髋关节置换术（THA）的患者进行临床和影像学评估。假设术前臀肌-肌腱单位的退变状态与功能恢复方面的临床结果之间存在相关性。
55 名符合纳入标准的患者。所有纳入样本的患者均接受临床评估。对研究患者进行超声检查，评估以下参数：臀中肌肌腱厚度（mm）；臀中肌肌腱质量；和 trophy 及肌肉成分。
术前肌腱退变程度与所有术前和术后临床评分均呈负相关，但仅与术后 Harris、术后 Oxford、改良术后 Harris 和 HOOS、跛行和单足站立试验呈统计学意义（p<0.05）；与术中检测到的宏观肌腱质量、术前对侧肌腱程度以及手术侧和对侧术前肌肉呈正相关（p<0.05）。术前手术肌肉的脂肪变性程度与除术前 WOMAC 和改良 HOOS 以外的所有术前和术后临床评分呈负相关（p<0.05），与跛行和单足站立试验呈负相关；与年龄、术中检测到的宏观肌腱质量、肌腱退变程度、对侧术前和术后肌肉以及术后手术肌肉的脂肪浸润呈正相关（p<0.05）。
臀中肌肌腱退变和脂肪浸润似乎是髋关节置换术后患者跛行和单足站立试验阳性持续存在的决定因素。
