Baker Champ L, Mahoney J Ryan
The Hughston Clinic, Columbus, Georgia, USA.
Jack Hughston Memorial Hospital, Phenix City, Alabama, USA.
Orthop J Sports Med. 2020 Mar 19;8(3):2325967120907868. doi: 10.1177/2325967120907868. eCollection 2020 Mar.
Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described.
To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy.
Case series; Level of evidence, 4.
A total of 29 patients with gluteal tendinopathy (mean age, 62 years) who did not respond to nonsurgical treatment were enrolled in this prospective study and underwent ultrasound-guided PUT in an outpatient setting. Patients with a history of ipsilateral hip surgery were excluded. All patients initially underwent magnetic resonance imaging or a computed tomography arthrogram demonstrating tendinopathy and/or partial tearing of the gluteus minimus or medius tendon or both tendons. Outcomes were assessed with a visual analog scale (VAS) for pain, the Harris Hip Score evaluation, and the 12-Item Short Form Health Survey (SF-12) before the procedure and at subsequent follow-up visits or by telephone interviews at 3 weeks, 3 months, 6 months, and final follow-up (range, 18-30 months).
The mean final follow-up was at 22 months postoperatively. At final follow-up, VAS scores had improved from a preprocedural mean ± SD of 5.86 ± 1.73 to 2.82 ± 2.22 ( < .01). Harris Hip Scores improved from a preprocedural mean of 60.03 ± 10.86 to 77.47 ± 14.34 ( < .01). Total SF-12 scores improved from a mean of 29.93 ± 5.39 (51% optimal) to 34.41 ± 4.88 (64% optimal) ( < .01). No complications were reported. At final follow-up, when asked whether they would have the procedure again, 15 patients replied "yes definitely," 3 replied "yes probably," 3 replied "maybe," 1 replied "likely not," and 2 replied "definitely not." There were 3 patients who eventually had hip abductor tendon repair, and their PUT procedures were considered failures.
PUT is an effective treatment, with good results for patients with gluteal tendinopathy.
臀肌肌腱病是髋关节外侧疼痛的常见原因。经皮超声肌腱切断术（PUT）已成功用于治疗肘部、膝部和踝部的肌腱病，但尚未见其在髋关节应用的报道。
评估经皮超声肌腱切断术（PUT）对非手术治疗无效的臀肌肌腱病患者的疗效。
病例系列；证据等级，4级。
本前瞻性研究纳入了29例非手术治疗无效的臀肌肌腱病患者（平均年龄62岁），在门诊接受超声引导下的PUT治疗。排除同侧髋关节手术史患者。所有患者最初均接受磁共振成像或计算机断层扫描关节造影，显示臀小肌或臀中肌肌腱或两者肌腱的肌腱病和/或部分撕裂。在手术前以及随后的随访中或通过3周、3个月、6个月和最终随访（范围18 - 30个月）的电话访谈，使用视觉模拟量表（VAS）评估疼痛、Harris髋关节评分以及12项简短健康调查问卷（SF - 12）。
最终随访平均在术后22个月。在最终随访时，VAS评分从术前平均±标准差5.86±1.73改善至2.82±2.22（P <.01）。Harris髋关节评分从术前平均60.03±10.86提高到77.47±14.34（P <.01）。SF - 12总分从平均29.93±5.39（最佳值的51%）提高到34.41±4.88（最佳值的64%）（P <.01）。未报告并发症情况。在最终随访时，当被问及是否愿意再次接受该手术时，15例患者回答“肯定愿意”，3例回答“可能愿意”，3例回答“也许愿意”，1例回答“可能不愿意”，2例回答“肯定不愿意”。有3例患者最终进行了髋外展肌肌腱修复，他们的PUT手术被认为失败。
经皮超声肌腱切断术（PUT）是一种有效的治疗方法，对臀肌肌腱病患者效果良好。
