Orthopaedic Department, Hospital de la Tour, Geneva, Switzerland.
Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.
Hip Int. 2021 Nov;31(6):751-758. doi: 10.1177/1120700020924330. Epub 2020 May 13.
The treatment options of chronic abductor insufficiency in the setting of muscle degeneration, are limited and technically demanding. We present the outcomes of a salvage technique for unreconstructable, chronic abductor tears performed by a single surgeon.
We retrospectively evaluated 38 patients who were surgically managed for chronic abductor insufficiency. Patients without hip implants and patients following primary or revision total hip arthroplasty (THA) were involved. All patients had a Trendelenburg gait, impaired muscle strength of abduction (⩽M4) and fatty degeneration of muscles (Goutallier ⩾3). They underwent transfer of a flap of the anterior third of gluteus maximus to the greater trochanter that was sutured under the slightly mobilised vastus lateralis. The level of pain, functional scores, muscle strength and Trendelenburg gait were re-evaluated at 12 postoperative months.
The mean age of patients was 70.2 years. 10 patients received the tendon transfer on a native hip, 6 following primary THA and 22 after revision THA. The mean pain level (3.2 vs. 7, 0.001) and Harris Hip Score (80.2 vs. 41.6, 0.001) and the median abductor strength (4 vs. 3, 0.001) was significantly improved compared to the preoperative scores. 26 patients demonstrated negative and 12 positive Trendelenburg sign at 12 postoperative months. No serious complications were reported.
This salvage technique improved the strength of abduction and functional results and reduced the level of pain in 80% of patients with chronic abductor tears. The short-term outcomes of the procedure were favourable; however, further evaluation is needed.
在肌肉退行性变的情况下，慢性外展肌功能不全的治疗选择有限且技术要求高。我们介绍了一位外科医生对不可重建的慢性外展肌撕裂进行挽救性治疗的结果。
我们回顾性评估了 38 例接受慢性外展肌功能不全手术治疗的患者。研究对象包括无髋关节植入物的患者和初次或翻修全髋关节置换术（THA）后的患者。所有患者均有臀中肌步态，外展肌力减弱（⩽M4）和肌肉脂肪变性（Goutallier ⩾3）。他们接受了阔筋膜张肌前 1/3 瓣的转移，转移至大转子，然后在轻度活动的股外侧肌下缝合。在术后 12 个月，重新评估疼痛程度、功能评分、肌肉力量和臀中肌步态。
患者的平均年龄为 70.2 岁。10 例患者在原髋关节接受肌腱转移术，其中 6 例为初次 THA 后，22 例为翻修 THA 后。与术前评分相比，疼痛水平（3.2 对 7， 0.001）、Harris 髋关节评分（80.2 对 41.6， 0.001）和外展肌平均力量（4 对 3， 0.001）均显著改善。术后 12 个月，26 例患者臀中肌步态呈阴性，12 例呈阳性。无严重并发症报告。
这种挽救性技术改善了 80%慢性外展肌撕裂患者的外展力量和功能结果，并减轻了疼痛程度。该手术的短期效果良好；然而，需要进一步评估。
