Fujii Masashi, Kijima Hiroaki, Kaya Mitsunori, Miyakoshi Naohisa
Orthopedic Surgery, Akita City Hospital, Akita, JPN.
Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, JPN.
Cureus. 2022 Mar 26;14(3):e23515. doi: 10.7759/cureus.23515. eCollection 2022 Mar.
Iliopectineal bursitis usually develops subsequent to other hip pathologies and can often be treated conservatively. However, when conservative treatment fails or the enlarged bursa causes pain or compression of the surrounding neurovascular structures, surgery may be required. Most previous studies have described open surgeries, and reports on endoscopy are very limited. We present a case of iliopectineal bursitis associated with developmental dysplasia of the hip (DDH) that was successfully treated endoscopically. A 16-year-old female with a one-year history of right inguinal pain was referred to our department. She was diagnosed with a hip ganglion and treated with needle aspiration nine times by her previous doctor. Radiographs revealed bilateral DDH without narrowing of the joint space. Magnetic resonance imaging revealed a distinct mass in the deep layer of the iliopsoas muscle, and communication between the mass and the hip joint was observed on ultrasonography. Endoscopic debridement and resection were performed based on the diagnosis of iliopectineal bursitis. We partially debrided the medial side of the rectus femoris muscle toward the deep layer and resected the bursa. We observed a burst of concentrated content from the bursa and confirmed the disappearance of the mass by intraoperative ultrasonography. The postoperative course was good, and there were no functional restrictions or symptom recurrence at two-year postoperatively. Endoscopic resection for repetitive iliopectineal bursitis without an intraarticular procedure does not induce hip instability in patients with DDH and is a minimally invasive cosmetic procedure, and superior to open surgery, especially in young women.
髂耻滑囊炎通常继发于其他髋关节病变，且往往可采用保守治疗。然而，当保守治疗失败或肿大的滑囊引起疼痛或压迫周围神经血管结构时，可能需要手术治疗。以往大多数研究描述的是开放手术，关于内镜手术的报道非常有限。我们报告一例与髋关节发育不良（DDH）相关的髂耻滑囊炎，通过内镜手术成功治愈。一名16岁女性，有1年右侧腹股沟疼痛病史，转诊至我科。她曾被诊断为髋关节腱鞘囊肿，之前的医生对其进行了9次穿刺抽吸治疗。X线片显示双侧DDH，关节间隙无狭窄。磁共振成像显示髂腰肌深层有一明显肿块，超声检查发现肿块与髋关节相通。根据髂耻滑囊炎的诊断进行了内镜清创和切除术。我们向深层部分清创股直肌内侧，并切除滑囊。我们观察到滑囊中有大量浓缩物涌出，并通过术中超声确认肿块消失。术后恢复良好，术后两年无功能受限或症状复发。对于复发性髂耻滑囊炎，在内镜下切除而不进行关节内手术，不会导致DDH患者髋关节不稳定，是一种微创美容手术，优于开放手术，尤其对于年轻女性。
