Department of Orthopedics and Traumatology, HSU Prof. Cemil Tascioglu City Hospital, Istanbul, Turkey.
Department of Orthopedics and Traumatology, Liv Hospital Bahcesehir, 469683Istinye University Hospital, Istanbul, Turkey.
J Orthop Surg (Hong Kong). 2021 Jan-Apr;29(1):23094990211003349. doi: 10.1177/23094990211003349.
The posterior approach (PA) is the most commonly used surgical approach for total hip arthroplasty (THA), but the proximity of the sciatic nerve may increase the likelihood of sciatic nerve injury (SNI). Gluteus maximus tenotomy can be performed to prevent SNI because tenotomy increases the distance between the femoral neck and sciatic nerve and prevents compression of the sciatic nerve by the gluteus maximus tendon (GMT) during hip movements. We aimed to kinematically compare the postoperative hip extensor forces of patients who have and have not undergone gluteus maximus tenotomy to determine whether there is a difference in hip extensor strength.
Seventy-two patients who underwent gluteus maximus tenotomy during THA were included in the group 1, and 86 patients who did not undergo tenotomy were included in group 2. The Harris hip score, body mass index and hip extensor forces were measured both preoperatively, and 6 months after surgery with an isokinetic dynamometer and compared.
The mean age was 64.6 ± 2.3 years in group 1 and 63.8 ± 2.1 in group 2. Mean body mass index was 25.7 ± 1.1 in group 1, and 25.5 ± 1.3 in group 2. Baseline Harris hip score (HHS) was 42.36 ± 12 in group 1 and 44.07 ± 9.4 in group 2 (p = 0.31), whereas it was 89.1 ± 7.8 and 88.4 ± 8.1 at 6 months after surgery, respectively. Baseline hip extensor force (HEF) was 2 ± 0.4 Nm/kg in group 1, and 2.1 ± 0.7 Nm/kg in group 2 (p = 0.28), while it was 2.4 ± 0.6 Nm/kg, and 2.5 ± 0.5 Nm/kg, respectively at 6 month follow-up (p = 0.87). Both groups had significantly improved HHS and HEF when comparing baseline and postoperative measurements (p < 0.0001). No cases of sciatic nerve palsy were noted in group 1, whereas there were two (2.32%) cases in group 2, postoperatively.
The release of the GMT during primary hip arthroplasty performed with the PA did not lead to significant decrease in hip extension forces. Hip extensor strength improves after THA regardless of tenotomy. Gluteus maximus tenotomy with repair does not reduce muscle strength and may offer better visualization.
后路（PA）是全髋关节置换术（THA）最常用的手术入路，但坐骨神经的邻近可能增加坐骨神经损伤（SNI）的可能性。可以进行臀大肌切断术来预防 SNI，因为切断术增加了股骨颈和坐骨神经之间的距离，并防止了在髋关节运动过程中 GMT 对坐骨神经的压迫。我们旨在通过运动学比较接受和未接受臀大肌切断术的 THA 患者的术后髋关节伸肌力量，以确定髋关节伸肌力量是否存在差异。
72 例在 THA 期间接受臀大肌切断术的患者被纳入组 1，86 例未接受切断术的患者被纳入组 2。使用等速测力计测量术前和术后 6 个月的 Harris 髋关节评分、体重指数和髋关节伸肌力量，并进行比较。
组 1 的平均年龄为 64.6±2.3 岁，组 2 为 63.8±2.1 岁。组 1 的平均体重指数为 25.7±1.1，组 2 为 25.5±1.3。组 1 的基线 Harris 髋关节评分（HHS）为 42.36±12，组 2 为 44.07±9.4（p=0.31），而术后 6 个月时，组 1 为 89.1±7.8，组 2 为 88.4±8.1。组 1 的基线髋关节伸肌力量（HEF）为 2±0.4 Nm/kg，组 2 为 2.1±0.7 Nm/kg（p=0.28），而术后 6 个月时，组 1 为 2.4±0.6 Nm/kg，组 2 为 2.5±0.5 Nm/kg（p=0.87）。两组在比较基线和术后测量值时，HHS 和 HEF 均显著改善（p<0.0001）。组 1 无坐骨神经麻痹病例，而组 2 术后有 2 例（2.32%）。
PA 行初次髋关节置换术中 GMT 的释放并未导致髋关节伸肌力量显著下降。THA 后髋关节伸肌力量均有改善，与切断术无关。臀大肌切断术并修复不会降低肌肉力量，并且可能提供更好的可视化效果。
