American Hip Institute Research Foundation, Chicago, Illinois, USA.
AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.
Am J Sports Med. 2021 Jun;49(7):1759-1768. doi: 10.1177/03635465211008104. Epub 2021 May 6.
Pertrochanteric calcifications can be found in patients with greater trochanteric pain syndrome (GTPS). A systematic description of the types and prevalence of these calcifications has not been undertaken. Furthermore, there is conflicting evidence regarding their association with abductor tendon injuries.
(1) To describe the various types and prevalence of pertrochanteric calcifications in patients presenting for the surgical management of recalcitrant GTPS. (2) To evaluate the association of the various calcifications with intraoperatively diagnosed hip abductor tendon injuries, including tendinosis, partial-thickness tears, and full-thickness tears.
Cross-sectional study; Level of evidence, 3.
Patients undergoing surgical management for GTPS, in isolation or as an ancillary procedure during hip arthroscopy for femoroacetabular impingement, between April 2008 and February 2020 were included. Of these, 85 procedures were isolated treatment of GTPS and the remaining 628 were ancillary to hip arthroscopy. Radiographs were scrutinized for the presence of pertrochanteric calcifications. The hip abductor tendon status was intraoperatively classified as intact, partial-thickness tear, or full-thickness tear. The prevalence and correlation of the various radiographic findings in relation to the intraoperatively classified tendon condition were analyzed via the odds ratio (OR).
Surgery was performed on 713 hips with recalcitrant GTPS. No tear was found in 340 hips (47.7%), 289 hips (40.5%) had a partial-thickness tear, and 84 hips (11.8%) had a full-thickness tear. Radiographically, 102 hips (14.3%) demonstrated proximally directed enthesophytes, and 34 (4.8%) had distally directed enthesophytes. In addition, 75 hips (10.5%) had amorphous calcifications, 47 (6.6%) had isolated ossicles, and 110 (15.4%) had surface irregularities. The presence of any calcification was associated with partial-thickness tears (OR, 1.67 [95% CI, 1.21-2.21]; = .002) and full-thickness tears (OR, 6.40 [95% CI, 3.91-10.47]; < .001). Distally directed enthesophytes (OR, 10.18 [95% CI, 3.08-33.63]; < .001) and proximally directed enthesophytes (OR, 8.69 [95% CI, 4.66-16.21]; < .001) were the findings with the highest OR for the presence of any type of tear. Distally directed enthesophytes were the findings with the highest OR for a full-thickness tear (OR, 15.79 [95% CI, 7.55-33.06]; < .001). Isolated ossicles were the findings with the highest OR for a partial-thickness tear (OR, 1.73 [95% CI, 0.96-3.13]; = .070).
Pertrochanteric calcifications were common radiographic findings in patients with GTPS and can help guide management in these patients. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear, and increasing size of the findings was associated with more severe tendon injuries.
大转子疼痛综合征（GTPS）患者可出现转子间钙化。尚未对这些钙化的类型和流行情况进行系统描述。此外，关于它们与外展肌腱损伤的关系存在相互矛盾的证据。
（1）描述接受顽固性 GTPS 手术治疗的患者中转子间各种类型和流行的钙化情况。（2）评估各种钙化与术中诊断的髋关节外展肌腱损伤（包括肌腱病、部分厚度撕裂和全厚度撕裂）的关联。
横断面研究；证据水平，3 级。
纳入 2008 年 4 月至 2020 年 2 月期间因 GTPS 接受手术治疗的患者，单独接受或作为髋关节镜检查治疗股骨髋臼撞击症的辅助手术。其中，85 例为 GTPS 的单独治疗，其余 628 例为髋关节镜检查的辅助治疗。仔细检查 X 线片以确定转子间钙化的存在。术中将髋关节外展肌腱的状态分类为完整、部分厚度撕裂或全厚度撕裂。通过比值比（OR）分析各种影像学发现与术中分类的肌腱状况的相关性和流行情况。
对 713 例 GTPS 患者进行了手术治疗。340 髋（47.7%）未发现撕裂，289 髋（40.5%）有部分厚度撕裂，84 髋（11.8%）有全厚度撕裂。X 线片显示 102 髋（14.3%）存在近端指向的附着点骨赘，34 髋（4.8%）存在远端指向的附着点骨赘。此外，75 髋（10.5%）有不定形钙化，47 髋（6.6%）有孤立骨化，110 髋（15.4%）有表面不规则。存在任何钙化与部分厚度撕裂（OR，1.67 [95%CI，1.21-2.21]； =.002）和全厚度撕裂（OR，6.40 [95%CI，3.91-10.47]； <.001）相关。远端指向的附着点骨赘（OR，10.18 [95%CI，3.08-33.63]； <.001）和近端指向的附着点骨赘（OR，8.69 [95%CI，4.66-16.21]； <.001）是与任何类型撕裂存在的最高 OR 的发现。远端指向的附着点骨赘是全厚度撕裂（OR，15.79 [95%CI，7.55-33.06]； <.001）的最高 OR 发现。孤立骨化是部分厚度撕裂（OR，1.73 [95%CI，0.96-3.13]； =.070）的最高 OR 发现。
转子间钙化是 GTPS 患者常见的 X 线表现，可帮助指导这些患者的治疗。近端和远端指向的附着点骨赘是髋关节外展肌腱撕裂（特别是全厚度撕裂）存在的有力预测因素，并且发现的大小增加与更严重的肌腱损伤相关。
