Pumarejo Gomez Laura, Li Daniel, Childress John M.
Cleveland Clinic, Northwestern University, The Ohio State University
Florida International University
Patients diagnosed with lateral hip pain are commonly treated for trochanteric bursitis using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and physical therapy. While effective for many, this approach still leaves many patients with ongoing discomfort and limited functionality. Recent advancements in understanding have led to the recognition of greater trochanteric pain syndrome (GTPS) as a more accurate descriptor of this condition. GTPS encompasses trochanteric bursitis, external coxa saltans (snapping hip), and abductor tendinopathy. Trochanteric bursitis, the predominant cause of GTPS, involves inflammation of the greater trochanteric bursa, which is located between the greater trochanter and the iliotibial band. This inflammation is commonly triggered by repetitive stress and trauma. The condition manifests as pain in the lateral thigh, often aggravated by prolonged sitting, stair climbing, or engaging in high-impact exercises. The hip joint, bearing loads of 6 to 8 times the body weight during everyday activities, is particularly vulnerable to wear and tear. The diagnosis of GTPS is primarily clinical, with imaging used to differentiate it from other potential causes. A deep understanding of the relevant anatomy, clinical examination findings, and imaging results is essential in managing cases resistant to conservative treatment. The standard treatment includes NSAIDs, physical therapy, and stretching exercises. Surgical intervention, both open and endoscopic, is reserved for cases where conservative methods are ineffective. Dysfunction at any anatomical junction can manifest as greater trochanteric pain syndrome. The peritrochanteric space contains important anatomical structures that enable hip motion and stability. A key structure is the subgluteus maximus bursa, also called the trochanteric bursa, which cushions movements of the overlying gluteus tendons, iliotibial band, and tensor fascia lata. The peritrochanteric space is superficially covered by a fibromuscular sheath comprising the gluteus maximus, tensor fascia lata, and iliotibial band. Underneath lie the hip abductor and stabilizer muscles. The gluteus minimus stabilizes the femoral head, originating from the pelvis and inserting at the greater trochanter. The larger gluteus medius also inserts at the greater trochanter, initiates hip abduction, and stabilizes the femoral head. Finally, the tensor fascia lata forms the prime hip abductor. Proper functioning of these muscular and connective tissue structures enables painless motion and transfers weight laterally from the hip during gait.
被诊断为髋关节外侧疼痛的患者通常采用非甾体类抗炎药（NSAIDs）、皮质类固醇注射和物理治疗来治疗转子滑囊炎。虽然这种方法对许多患者有效，但仍有许多患者持续不适且功能受限。最近在认识方面的进展导致人们认识到，大转子疼痛综合征（GTPS）是对这种情况更准确的描述。GTPS包括转子滑囊炎、外展髋（弹响髋）和外展肌肌腱病。转子滑囊炎是GTPS的主要病因，涉及大转子滑囊的炎症，该滑囊位于大转子和髂胫束之间。这种炎症通常由重复性压力和创伤引发。该病表现为大腿外侧疼痛，长时间坐着、爬楼梯或进行高强度运动时疼痛往往会加重。髋关节在日常活动中承受着体重6至8倍的负荷，特别容易受到磨损。GTPS的诊断主要依靠临床诊断，影像学检查用于将其与其他潜在病因区分开来。深入了解相关解剖结构、临床检查结果和影像学结果对于处理对保守治疗有抵抗性的病例至关重要。标准治疗包括使用NSAIDs、物理治疗和伸展运动。对于保守方法无效的病例，则采用开放手术和内镜手术干预。任何解剖关节处的功能障碍都可能表现为大转子疼痛综合征。转子周围间隙包含重要的解剖结构，这些结构有助于髋关节的运动和稳定。一个关键结构是臀大肌下滑囊，也称为转子滑囊，它缓冲覆盖其上的臀肌腱、髂胫束和阔筋膜张肌的运动。转子周围间隙表面覆盖着一层纤维肌肉鞘，由臀大肌、阔筋膜张肌和髂胫束组成。其下方是髋关节外展肌和稳定肌。臀小肌稳定股骨头，起自骨盆，止于大转子。较大的臀中肌也止于大转子，启动髋关节外展并稳定股骨头。最后，阔筋膜张肌是主要的髋关节外展肌。这些肌肉和结缔组织结构的正常功能可实现无痛运动，并在步态中使体重从髋关节侧向转移。
