髋关节稳定性可能影响大转子疼痛综合征的发生发展：一项对连续患者的病例对照研究。
Hip Stability May Influence the Development of Greater Trochanteric Pain Syndrome: A Case-Control Study of Consecutive Patients.
作者信息
Goldman Lcdr Ashton H, Land Ens Vaughn, Adsit Matthew H, Balazs Cdr George C
机构信息
Bone and Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
Eastern Virginia Medical School, Norfolk, Virginia, USA.
出版信息
Orthop J Sports Med. 2020 Nov 9;8(11):2325967120958699. doi: 10.1177/2325967120958699. eCollection 2020 Nov.
BACKGROUND
Greater trochanteric pain syndrome (GTPS) is thought to relate primarily to tendinosis/tendinopathy of the hip abductors. Previous studies have suggested that certain anatomic factors may predispose one to development of the condition.
HYPOTHESIS
It was hypothesized that intrinsic acetabular bony stability of the hip is related to the development of GTPS.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
A total of 198 consecutive patients diagnosed with GTPS were compared with 198 consecutive patients without clinical evidence of GTPS. Electronic health records of the included patients were examined; data recorded included patient age, sex, race, and body mass index (BMI). Standing anteroposterior radiographs were evaluated by 2 blinded examiners who measured the Tönnis angle, lateral center-edge angle (LCEA), and acetabular depth/width ratio (ADW) and assessed for the presence of a posterior wall sign. The number of dysplastic measures was recorded for each patient based on published norms. Associations between radiographic and patient variables versus the presence or absence of GTPS were determined. Factors with univariate associations where < .20 were included in a binary logistic regression model to identify independent predictors of the presence of GTPS.
RESULTS
There was no difference between groups in terms of age, BMI, or race. There were significantly more women than men in the GTPS group (71% vs 30%; < .001). Intraclass correlation coefficients were good for the LCEA (0.82) and Tönnis angle (0.82) and poor (0.08) for the ADW. Kappa was moderate for the presence of a posterior wall sign (0.51). An increased Tönnis angle, decreased ADW, and ADW <0.25 were significantly associated with the presence of GTPS. The binary logistic regression model identified an increased Tönnis angle ( < .010) and female sex ( < .001) as independent risk factors for GTPS.
CONCLUSION
Based on this preliminary retrospective study, decreased intrinsic acetabular bony stability of the hip may be associated with an increased risk of GTPS.
背景
大转子疼痛综合征（GTPS）被认为主要与髋外展肌的肌腱病/肌腱病变有关。先前的研究表明，某些解剖学因素可能使人易患此病。
假设
假设髋部髋臼的内在骨稳定性与GTPS的发生有关。
研究设计
横断面研究；证据等级，3级。
方法
将198例连续诊断为GTPS的患者与198例无GTPS临床证据的连续患者进行比较。检查纳入患者的电子健康记录；记录的数据包括患者年龄、性别、种族和体重指数（BMI）。由2名 blinded 检查者评估站立前后位X线片，他们测量Tönnis角、外侧中心边缘角（LCEA）和髋臼深度/宽度比（ADW），并评估后壁征的存在情况。根据已发表的标准记录每位患者发育异常测量的数量。确定X线片和患者变量与GTPS存在与否之间的关联。单变量关联中P<0.20的因素纳入二元逻辑回归模型，以确定GTPS存在的独立预测因素。
结果
两组在年龄、BMI或种族方面无差异。GTPS组女性明显多于男性（71%对30%；P<0.001）。LCEA（0.82）和Tönnis角（0.82）的组内相关系数良好，而ADW的组内相关系数较差（0.08）。后壁征存在情况的kappa值为中等（0.51）。Tönnis角增大、ADW减小以及ADW<0.25与GTPS的存在显著相关。二元逻辑回归模型确定Tönnis角增大（P<0.010）和女性性别（P<0.001）是GTPS的独立危险因素。
结论
基于这项初步的回顾性研究，髋部髋臼内在骨稳定性降低可能与GTPS风险增加有关。
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