Carbonell-Rosell Carla, Soza Diego, Pujol Oriol, de Albert de Delás-Vigo Matias, Antón Alba, Barro Victor
Hip Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
J Orthop. 2022 Aug 27;34:137-141. doi: 10.1016/j.jor.2022.08.023. eCollection 2022 Nov-Dec.
The first surgical option considered in managing iliopsoas impingement following THA is endoscopic/arthroscopic iliopsoas tenotomy, because of its low risk and minimal invasiveness. Acetabular revision is a much more aggressive surgery, recommended only in cases of substantial cup malposition. However, there are no clear indications for this procedure. The purpose of this article is to analyse the role of CT-scan measurement of acetabular cup positioning in a therapeutic algorithm for iliopsoas impingement.
In this retrospective observational study, we reviewed 25 patients treated for iliopsoas impingement following THA between 2011 and 2019. We studied acetabular cup positioning using CT-scan. We compared radiological parameters of patients who presented with significant clinical improvement with conservative treatment and with tenotomy against those who did not. Finally, we developed a proposed therapeutic algorithm.
Forty-eight percent of patients presented a significant clinical improvement following conservative treatment. Patients who did not improve were found to have greater acetabular cup axial and sagittal overhang (p-values 0.016 and 0.003). These patients were considered for tenotomy. Of this group, those who did not improve with surgery (38%) showed greater axial overhang (p-value 0.005).
Conservative management should be the first line of treatment. In cases of non-operative treatment failure, axial acetabular cup overhang measured by CT-scan can be a useful tool in choosing between iliopsoas tenotomy or cup-revision surgery in selected cases of very severe acetabular malposition. A cut-off point of 10 mm of axial overhang is a reliable predictor of higher failure risk with iliopsoas tenotomy.
在全髋关节置换术（THA）后处理髂腰肌撞击症时，首先考虑的手术选择是内镜/关节镜下髂腰肌切断术，因其风险低且创伤小。髋臼翻修术是一种更为激进的手术，仅在髋臼杯严重位置异常的情况下推荐使用。然而，对于该手术尚无明确的指征。本文的目的是分析在髂腰肌撞击症治疗算法中，CT扫描测量髋臼杯位置的作用。
在这项回顾性观察研究中，我们回顾了2011年至2019年间接受THA后髂腰肌撞击症治疗的25例患者。我们使用CT扫描研究髋臼杯的位置。我们比较了经保守治疗和切断术有显著临床改善的患者与未改善患者的放射学参数。最后，我们制定了一个建议的治疗算法。
48%的患者经保守治疗后有显著临床改善。未改善的患者髋臼杯轴向和矢状位悬垂更大（p值分别为0.016和0.003）。这些患者被考虑进行切断术。在这组患者中，手术未改善的患者（38%）轴向悬垂更大（p值为0.005）。
保守治疗应作为一线治疗方法。在非手术治疗失败的情况下，对于髋臼严重位置异常的特定病例，CT扫描测量的髋臼杯轴向悬垂可作为在髂腰肌切断术或髋臼翻修手术之间进行选择的有用工具。轴向悬垂10毫米的临界点是髂腰肌切断术失败风险较高的可靠预测指标。
