Coulomb Remy, Nougarede Bastien, Maury Etienne, Marchand Philippe, Mares Olivier, Kouyoumdjian Pascal
Nîmes University Hospital (CHU Nimes), Nîmes, France.
Hip Int. 2022 Jan;32(1):4-11. doi: 10.1177/1120700020970519. Epub 2020 Nov 23.
To evaluate the technique, results and complications of arthroscopic iliopsoas tenotomies either on native hips or total hip arthroplasty (THA).
A systematic review was performed using 3 databases: PubMed, EMBASE and the Cochrane library from January 2000 to December 2018 in accordance with the PRISMA procedure. The literature search, data extraction and quality assessment were conducted by 2 independent reviewers. Surgical technique, clinical outcomes, recurrences and complication rate were evaluated.
Out of 115 articles reviewed, 20 articles concerned native hips and 8 articles THA. 3 levels of release were described. For native hips, the recurrence rate was higher for central compartment than peripheral or lesser trochanter releases. Complication rates were similar for hip arthroscopy but remained low in all series. Loss of strength was evaluated mainly using the MRC muscle scale. Most studies noted strength recovery. MRI analysis of muscle atrophy was greater for lesser trochanter than for central compartment release but unrelated to loss of strength. The complication rate was low for tenotomy after THA, heterotopic ossification being the most common complication.
Central compartment releases lead to the highest rate of recurrence due to incomplete release. Peripheral releases have a potential risk of vascular injury. The lesser trochanteric approach has the disadvantage of not having direct access to the joint. The main difficulty with THA lies in the diagnosis of cup/iliopsoas impingement. Diagnostic tests with infiltration should be made before iliopsoas release to prevent its failure. Cup protrusion of over 8mm is a potential indication for acetabular revision.
评估在天然髋关节或全髋关节置换术（THA）中进行关节镜下髂腰肌肌腱切断术的技术、结果及并发症。
按照PRISMA流程，于2000年1月至2018年12月使用3个数据库（PubMed、EMBASE和Cochrane图书馆）进行系统评价。文献检索、数据提取和质量评估由2名独立评审员进行。对手术技术、临床结果、复发情况及并发症发生率进行评估。
在115篇综述文章中，20篇涉及天然髋关节，8篇涉及THA。描述了3种松解水平。对于天然髋关节，中央腔室松解的复发率高于外周或小转子松解。髋关节镜检查的并发症发生率相似，但在所有系列中均保持较低水平。主要使用医学研究委员会（MRC）肌肉评分评估肌力丧失情况。大多数研究指出肌力有所恢复。小转子处肌肉萎缩的MRI分析结果大于中央腔室松解，但与肌力丧失无关。THA术后肌腱切断术的并发症发生率较低，异位骨化是最常见的并发症。
由于松解不完全，中央腔室松解导致的复发率最高。外周松解存在血管损伤的潜在风险。小转子入路的缺点是无法直接进入关节。THA的主要困难在于髋臼杯/髂腰肌撞击的诊断。在进行髂腰肌松解之前应进行浸润诊断测试，以防止手术失败。髋臼杯突出超过8mm是髋臼翻修的潜在指征。
