Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy. 2022 Jul;38(7):2115-2117. doi: 10.1016/j.arthro.2022.05.002.
The gluteus medius originates on the posterior face of the ilium between the posterior and anterior gluteal lines and inserts into the lateral and superoposterior facets of the greater trochanter. Because of the asymmetric nature of the muscle, tears are more likely to occur on the thinner anterolateral portion of the tendon footprint. Gluteus medius tears range from interstitial, partial thickness tears to retracted, full-thickness tears and may result from trauma, but they are more commonly the result of chronic degeneration. Patients commonly present with lateral hip pain aggravated by weight bearing and sleeping on the affected side, weakness in abduction, and the Trendelenburg sign observable on physical examination. Indications for surgery include failed conservative treatment and an ultrasound or magnetic resonance imaging study demonstrating a torn tendon. Surgical intervention aims to reapproximate and secure the torn tendon to the tendon footprint on the greater trochanter via suture anchors. Both open and endoscopic techniques have shown to be effective methods for treating gluteus medius tears at short- and long-term follow-up; however, endoscopic techniques have been shown to result in fewer postoperative complications, such as retear. A recent systematic review and meta-analysis found patients with more severe fatty infiltration (FI) may experience greater improvement after open repair, whereas patients with less severe FI may benefit more from endoscopic treatment. A double-row repair maximizes contact area between tendon and bone and has shown to be superior to single-row repair with an endoscopic technique.
臀中肌起于髂骨后侧面，后髂嵴线与前髂嵴线之间，插入大转子的外侧面和后上侧面。由于肌肉的不对称性，撕裂更可能发生在肌腱附着点较薄的前外侧部分。臀中肌撕裂的范围从间质性、部分厚度撕裂到回缩、全厚度撕裂，可能由创伤引起，但更常见于慢性变性。患者常表现为外侧髋关节疼痛，负重和向患侧睡觉时加重，外展无力，体检时可观察到特伦德伦伯格征。手术指征包括保守治疗失败和超声或磁共振成像研究显示肌腱撕裂。手术干预的目的是通过缝合锚将撕裂的肌腱重新接近并固定到大转子上的肌腱附着点。开放性和内窥镜技术在短期和长期随访中均被证明是治疗臀中肌撕裂的有效方法；然而，内窥镜技术已被证明可减少术后并发症，如再撕裂。最近的一项系统评价和荟萃分析发现，脂肪浸润（FI）更严重的患者在开放性修复后可能会有更大的改善，而 FI 程度较轻的患者可能从内窥镜治疗中获益更多。双排修复最大限度地增加了肌腱和骨之间的接触面积，并且与内窥镜技术的单排修复相比具有优越性。
