The First Affiliated Hospital of Zhejiang Chinese Medical University, Beijing, China.
The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
Arthroscopy. 2022 Jun;38(6):1900-1903. doi: 10.1016/j.arthro.2022.02.014.
Patients with femoroacetabular impingement syndrome (FAIS) often have extra-articular disorders, such as external snapping hip (ESH). We recommend that obvious ESH be addressed by endoscopic transversal iliotibial band (ITB) release during hip arthroscopy for FAIS because the residual serious snapping caused by ESH negatively affects the outcome of hip arthroscopy. However, for mild ESH without indications for severe trochanteric bursitis on magnetic resonance imaging, we still propose that physical therapy, extracorporeal shock wave therapy, or local injection be performed for pain relief. Surgical interventions for ESH including the Z-plasty technique and the modified Z-plasty technique for lengthening the ITB, as well as endoscopic cruciate or transversal incision in the ITB for release, have been reported with good results. Every technique has advantages and disadvantages, and we believe that surgeons should perform ITB release for ESH at the time of hip arthroscopy for FAIS based on their personal experience and inclination. In any case, excessive release of the ITB should be avoided. Finally, we wish to propose that more attention should be paid to the peri-greater trochanter (GT) space, an anatomic space between the ITB and the GT, which is similar to the subacromial space in the shoulder joint. Greater trochanteric pain syndrome (GTPS), related to the peri-GT space, is a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and ESH. Precise diagnosis and proper procedures for concurrent GTPS during surgery may improve the outcome of arthroscopy in patients with both FAIS and GTPS.
患有股骨髋臼撞击综合征（FAIS）的患者常有关节外疾病，如弹响髋（ESH）。我们建议在 FAIS 髋关节镜检查中通过关节镜下横向髂胫束（ITB）松解术来解决明显的 ESH，因为 ESH 引起的残留严重弹响会对髋关节镜手术的结果产生负面影响。然而，对于没有磁共振成像上严重转子滑囊炎指征的轻度 ESH，我们仍建议进行物理治疗、体外冲击波治疗或局部注射以缓解疼痛。ESH 的手术干预包括 Z 成形术技术和改良的 Z 成形术技术来延长 ITB，以及关节镜下 ITB 的十字形或横向切开以松解，这些技术都有良好的效果。每种技术都有其优缺点，我们认为外科医生应该根据个人经验和倾向，在 FAIS 髋关节镜检查时为 ESH 行 ITB 松解术。在任何情况下，都应避免过度松解 ITB。最后，我们希望提出更多关注髋关节周围（peri-GT）间隙的建议，这是 ITB 和 GT 之间的解剖间隙，类似于肩关节的肩峰下间隙。与 peri-GT 间隙相关的大转子后疼痛综合征（GTPS）是一种疾病谱，包括转子滑囊炎、外展肌腱病变和 ESH。在手术中准确诊断和同时处理 GTPS 可能会改善 FAIS 和 GTPS 患者的关节镜手术结果。
