Washington DC VA Medical Center, Department of Orthopedic Surgery Center, Washington, DC.
Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX.
J Arthroplasty. 2022 Jul;37(7S):S444-S448. doi: 10.1016/j.arth.2022.01.083. Epub 2022 Feb 18.
Hip abductor complex tears remain an injury without a clear consensus on management. Surgical treatment has been recommended after unsuccessful nonoperative management. This study evaluates both tenodesis and bone trough techniques, with treatment choices guided by previously described tear classification.
This is a retrospective cohort study of 45 hips in 44 patients who underwent surgical treatment for symptomatic, chronic hip abductor tear unresponsive to nonoperative treatment. Demographics and preoperative and postoperative values (including visual analog scale pain scores, gait assessment, and muscle strength) were evaluated. Type I tears were treated using tendon tenodesis. Type II tears were treated through a bone trough repair.
Forty-five hips (44 patients) were operated on with a minimum of 6-month follow-up. There were 27 type I and 18 type II tears. Eighty-seven percent of patients were female. Twenty-eight percent of type II patients (5/18) had a preexisting arthroplasty in place. Significant improvements in pain (P < .001), gait (P < .001), and muscle strength (P < .001) were achieved in both the tear types. Type I repairs showed superior results to type II repairs. However, both showed significant improvements. Postoperative magnetic resonance imaging at 6 months showed healed tenodesis in 81% (17/21) of type I tears and 50% (5/10) of type II tears.
Our study shows improvement in pain and function after surgical repair of hip abductor tendon injuries in both simple and complex tears. This improvement is seen even during ongoing surgical site healing. Magnetic resonance imaging findings may remain abnormal for more than 1 year after surgery and do not clearly denote repair failure.
髋关节外展肌复合体撕裂仍然是一种没有明确治疗共识的损伤。手术治疗被推荐用于非手术治疗失败的病例。本研究评估了肌腱固定术和骨槽技术,治疗选择根据先前描述的撕裂分类来指导。
这是一项回顾性队列研究,纳入了 44 名患者的 45 髋,这些患者因髋关节外展肌撕裂引起的慢性、症状性疾病,且对非手术治疗无反应而接受了手术治疗。评估了患者的人口统计学数据以及术前和术后数据(包括视觉模拟评分疼痛、步态评估和肌肉力量)。I 型撕裂采用肌腱固定术治疗。II 型撕裂采用骨槽修复术治疗。
45 髋(44 名患者)接受了手术治疗,随访时间至少为 6 个月。其中 27 髋为 I 型撕裂,18 髋为 II 型撕裂。87%的患者为女性。28%(5/18)的 II 型撕裂患者存在先前的关节置换术。两种类型的撕裂都取得了疼痛(P <.001)、步态(P <.001)和肌肉力量(P <.001)的显著改善。I 型修复的结果优于 II 型修复,但两者均有显著改善。术后 6 个月的磁共振成像显示,81%(17/21)的 I 型撕裂和 50%(5/10)的 II 型撕裂的肌腱固定术愈合。
我们的研究表明,在髋关节外展肌肌腱损伤的简单和复杂撕裂中,手术修复后疼痛和功能都得到了改善。这种改善甚至在手术部位愈合过程中也能看到。磁共振成像结果可能在手术后 1 年以上仍保持异常,且不能明确表示修复失败。