Maldonado David R, Annin Shawn, Chen Jeffery W, Rosinsky Philip J, Shapira Jacob, Lall Ajay C, Domb Benjamin G
American Hip Institute Research Foundation, Des Plaines, Illinois, USA.
Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Orthop J Sports Med. 2020 Jul 10;8(7):2325967120929330. doi: 10.1177/2325967120929330. eCollection 2020 Jul.
Gluteus medius (GM) tears are a well-established source of pain and disability. An open approach has been recognized with complete full-thickness and large GM tears, yet the current literature provides few reports on outcomes for this specific situation.
To report and analyze minimum 2-year patient-reported outcomes (PROs) from patients who underwent open GM repair in the setting of a full-thickness tear with or without concomitant hip arthroscopy through use of contemporary tendon repair techniques.
Case series; Level of evidence, 4.
Prospectively collected data were retrospectively reviewed for patients who underwent hip preservation surgery and total hip arthroplasty (THA) between April 2008 and May 2017. Patients were included in this study if they underwent open repair of GM full-thickness tears. The exclusion criteria were incomplete follow-up, workers' compensation status, repair regarding size and pattern of the GM, open repair of partial GM tear, open repair with allograft or autograft augmentation, and/or additional gluteus maximus transfer. Pre- and postoperative PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) score for pain and satisfaction were recorded. Statistical significance was set at < .05.
A total of 36 patients were included, of whom 12 received concomitant hip arthroscopy for intra-articular procedures. The mean ± SD age, body mass index, and follow-up time were 65.18 ± 12.69 years, 28.97 ± 4.95 kg/m, and 40.8 ± 26.19 months, respectively. At minimum 2-year follow-up, the following outcome measures improved significantly: mHHS (from 54.72 ± 15.89 to 73.12 ± 19.47; < .0001), NAHS (from 56.05 ± 12.47 to 75.22 ± 19.15; < .0001); HOS-SSS (from 20.30 ± 20.21 to 44.23 ± 35.85; < .0001), and VAS (from 4.95 ± 2.70 to 2.67 ± 2.81; < .0001). There was 1 (2.8%) conversion to THA at 48 months after the index procedure.
Patients who underwent open repairs in the setting of full-thickness GM tears via contemporary tendon repair techniques, with or without concomitant hip arthroscopy, achieved favorable results in several PRO scores at minimum 2-year follow-up.
臀中肌（GM）撕裂是疼痛和功能障碍的一个公认来源。对于完全全层和较大的GM撕裂，开放手术方法已得到认可，但目前文献中关于这种特定情况的结果报道较少。
报告并分析采用现代肌腱修复技术，在全层撕裂伴或不伴同期髋关节镜检查的情况下接受开放性GM修复的患者至少2年的患者报告结局（PROs）。
病例系列；证据等级，4级。
对2008年4月至2017年5月期间接受保髋手术和全髋关节置换术（THA）的患者的前瞻性收集数据进行回顾性分析。如果患者接受了GM全层撕裂的开放修复，则纳入本研究。排除标准为随访不完整、工伤赔偿状态、GM大小和形态的修复、部分GM撕裂的开放修复、同种异体或自体移植增强的开放修复，和/或额外的臀大肌转移。记录改良Harris髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）、髋关节结局评分运动特定子量表（HOS-SSS）以及疼痛和满意度的视觉模拟量表（VAS）评分的术前和术后PROs。统计学显著性设定为P <.05。
共纳入36例患者，其中12例接受了同期髋关节镜检查以进行关节内手术。平均±标准差年龄、体重指数和随访时间分别为65.18±12.69岁、28.97±4.95kg/m²和40.8±26.19个月。在至少2年的随访中，以下结局指标有显著改善：mHHS（从54.72±15.89提高到73. [12±19.47；P <.0001]，NAHS（从56.05±12.47提高到75.22±19.15；P <.0001）；HOS-SSS（从20.30±20.21提高到44.23±35.85；P <.0001），以及VAS（从4.95±2.70降低到2.67±2.81；P <.000l）。在初次手术后48个月有1例（2.8%）转为THA。
通过现代肌腱修复技术，在全层GM撕裂的情况下接受开放修复的患者，无论是否伴有同期髋关节镜检查，在至少2年的随访中，在多个PRO评分方面均取得了良好结果。
