Lee Sun-Ho, Jang Won-Young, Lee Min-Su, Yoon Taek-Rim, Park Kyung-Soon
Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
Hip Pelvis. 2023 Mar;35(1):24-31. doi: 10.5371/hp.2023.35.1.24. Epub 2023 Mar 6.
A response to conservative treatment is usually obtained in cases of ischiogluteal bursitis. However, the time required to achieve relief of symptoms can vary from days to weeks, and there is a high recurrence rate, thus invasive treatment in addition to conservative treatment can occasionally be effective. Therefore, the aim of this study was to examine surgical excision in cases of refractory ischiogluteal bursitis and to evaluate patients' progression and outcome.
A review of 21 patients who underwent surgical excision for treatment of ischiogluteal bursitis between February 2009 and July 2020 was conducted. Of these patients, seven patients were male, and 14 patients were female. Injection of steroid and local anesthetic into the ischial bursa was administered at outpatient clinics in all patients, who and they were refractory to conservative treatment, including aspiration and prescription drugs. Therefore, surgery was considered necessary. Excisions were performed by two orthopedic specialists using a direct vertical incision on the ischial area. A review of each patient was performed after excision, and quantification of the outcomes recorded using clinical scoring systems was performed.
The results of radiologic evaluation showed that the mean lesion size was 6.2 cm×4.5 cm×3.6 cm. The average disease course after excision was 21.6 days (range, 15-48 days). Measurement of clinical scores, including the visual analog scale and Harris hip scores, was performed during periodic visits, with scores of 0.7 (range, 0-2) and 98.1 (range, 96-100) at one postoperative month, respectively.
Surgical excision, with an expectation of favorable results, could be considered for treatment of ischiogluteal bursitis that is refractory to therapeutic injections, aspirations, and medical prescriptions, particularly in moderate-to-severe cases.
坐骨臀肌滑囊炎患者通常可通过保守治疗获得缓解。然而，症状缓解所需时间可能从数天到数周不等，且复发率较高，因此除保守治疗外，侵入性治疗偶尔也可能有效。因此，本研究的目的是探讨难治性坐骨臀肌滑囊炎的手术切除方法，并评估患者的病情进展和治疗效果。
回顾性分析2009年2月至2020年7月期间接受手术切除治疗坐骨臀肌滑囊炎的21例患者。其中男性7例，女性14例。所有患者均在门诊接受了类固醇和局部麻醉剂注射到坐骨滑囊内的治疗，这些患者对包括抽吸和药物处方在内的保守治疗均无效。因此，认为有必要进行手术。手术由两名骨科专家采用坐骨区域的直接垂直切口进行。术后对每位患者进行了复查，并使用临床评分系统对结果进行了量化记录。
影像学评估结果显示，平均病变大小为6.2 cm×4.5 cm×3.6 cm。切除术后平均病程为21.6天（范围15 - 48天）。在定期随访期间进行了包括视觉模拟量表和Harris髋关节评分在内的临床评分测量，术后1个月时的评分分别为0.7（范围0 - 2）和98.1（范围96 - 100）。
对于对治疗性注射、抽吸和药物处方难治的坐骨臀肌滑囊炎，尤其是中重度病例，可考虑手术切除，有望取得良好效果。
