Wakefield Orthopaedic Clinic, Adelaide, SA, Australia.
Data, Design and Statistical Service, Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, SA, Australia.
Hip Int. 2023 Sep;33(5):812-818. doi: 10.1177/11207000221103440. Epub 2022 Jun 5.
Gluteal tendons tears are increasingly being recognised as a cause of recalcitrant trochanteric pain, but there is a paucity of robust studies analysing the type of tears, results and predictors of outcome.
Patients with gluteal tendon tears resistant to conservative treatment who underwent isolated open repair (IR) or total hip arthroplasty and concomitant repair (THA+repair) with a minimum 1-year follow-up were retrospectively assessed separately. Type of tear, surgical approach, and fixation methods were registered. Complications and postoperative outcomes were analysed: visual analogue scale (VAS) of pain, VAS satisfaction, and activity level. Univariate regressions and multivariable models were developed.
90 cases were included: 62 cases underwent IR and 28 cases THA+repair, with an average follow-up of 3.9 years and 2.6 years, respectively. 13 complications were found ( = 5 IR, = 8 THA+repair), including 9 re-operations ( = 4 IR, = 5 THA+repair). Mean VAS pain score was 3.02 (SD 2.74) for the IR and 2.32 (SD 2.43) for THA+repair group. Mean VAS satisfaction was 7.09 (SD 3.07) and 7.68 (SD 2.71) for the IR and THA+repair group, respectively. In the IR group 61.4% returned to all pre-injury activities, whereas in the THA+repair group 79% did. Full-thickness tears had higher VAS pain scores ( = 0.0175), and there was trend ( > 0.05) towards higher complications, re-tears and lower VAS satisfaction in this type of tears in both groups. No statistically significant differences were found in outcomes when comparing THA+repair through direct anterior (DAA) with lateral approach (LA).
Isolated gluteal tendon repair or THA+repairs seem to be safe procedures with high levels of satisfaction at short- to mid-term follow-up. The presence of a full-thickness tear is a predictor of inferior outcomes.
臀肌腱撕裂越来越被认为是顽固性转子间疼痛的一个原因，但对于撕裂类型、结果和预后预测因素的研究很少。
分别回顾性评估了接受单纯切开修复（IR）或全髋关节置换术（THA）联合修复（THA+repair）的臀肌腱撕裂且对保守治疗有抵抗力的患者，这些患者均随访至少 1 年。记录撕裂类型、手术入路和固定方法。分析并发症和术后结果：疼痛视觉模拟评分（VAS）、VAS 满意度和活动水平。进行单变量回归和多变量模型分析。
共纳入 90 例患者，其中 62 例行 IR，28 例行 THA+repair，平均随访时间分别为 3.9 年和 2.6 年。共发现 13 例并发症（IR 为 5 例，THA+repair 为 8 例），包括 9 例再次手术（IR 为 4 例，THA+repair 为 5 例）。IR 组的平均 VAS 疼痛评分（SD=2.74）为 3.02，THA+repair 组为 2.32（SD=2.43）。IR 组的平均 VAS 满意度（SD=3.07）为 7.09，THA+repair 组为 7.68（SD=2.71）。IR 组中有 61.4%的患者恢复了所有术前活动，而 THA+repair 组中则有 79%的患者恢复了所有术前活动。在两组中，全层撕裂的 VAS 疼痛评分均较高（P=0.0175），且在该类型撕裂中，并发症、再撕裂的发生率较高，VAS 满意度较低，有趋势（P>0.05）。通过直接前入路（DAA）与外侧入路（LA）比较，THA+repair 组之间的结果无统计学差异。
孤立的臀肌腱修复或 THA+repair 似乎是安全的手术，在短期至中期随访中满意度较高。全层撕裂是预后不良的预测因素。
