Bitar Alexandre Carneiro, Guimarães Julio Brandão, Marques Ricardo, de Castro Trindade Christiano Augusto, Filho Alípio Gomes Ormond, Nico Marcelo Astolfi Caetano, de Amorim Cabrita Henrique Antônio Berwanger
Arch Bone Jt Surg. 2023;11(10):641-648. doi: 10.22038/ABJS.2023.70495.3304.
The study aimed to evaluate the clinical and radiological results after endoscopic repair of gluteus medius muscle injuries and proposed an anatomical classification for the different injury classes.
A retrospective case series, including patients who had undergone endoscopic repair of the hip abductor tendon. The surgical procedure was standardized. Magnetic resonance imaging (MRI) studies were analyzed, and the injuries were classified into three types: nontransfixing partial-extension (nTPE) tear, transfixing partial-extension (TPE) tear, and transfixing full-extension (TFE) tear. TPE and TFE were considered high-grade tears. The postoperative outcomes were as follows: duration of walking aid requirement, duration of physical therapy, time to return to daily activities, modified Harris Hip score (mHHS) and Nonarthritic Hip Score (NAHS) functional scores, pain visual analog scale (VAS), satisfaction, claudication, Trendelenburg test, and reoperation.
Sixteen patients were included (94% women; mean age 65 years), with a mean follow-up of 42 months (12-131, range). Out of the cases with preoperative exams available for analysis, four cases (31%) were nTPE, three (23%) TPE, and six (46%) TFE tears. Thus, 69% of the patients had high-grade injuries. These patients had a higher degree of fat infiltration (P = 0.034), but this was not correlated with inferior postoperative clinical or radiological results. One patient required reoperation due to a recurrent injury.
Isolated extra-articular injuries to the tendons of the gluteus medius and minimus evolved satisfactorily after endoscopic repair. Due to the small number of cases, it was not possible to observe differences in outcomes between high-and low-grade injuries.
本研究旨在评估内镜修复臀中肌损伤后的临床和影像学结果，并针对不同损伤类型提出一种解剖学分类方法。
一项回顾性病例系列研究，纳入接受髋外展肌腱内镜修复术的患者。手术操作标准化。分析磁共振成像（MRI）研究结果，并将损伤分为三种类型：非穿透性部分伸展（nTPE）撕裂、穿透性部分伸展（TPE）撕裂和穿透性完全伸展（TFE）撕裂。TPE和TFE被视为高级别撕裂。术后结果包括：辅助行走所需时间、物理治疗时间、恢复日常活动时间、改良Harris髋关节评分（mHHS）和非关节炎髋关节评分（NAHS）功能评分、疼痛视觉模拟量表（VAS）、满意度、跛行、Trendelenburg试验和再次手术情况。
纳入16例患者（94%为女性；平均年龄65岁），平均随访42个月（12 - 131个月，范围）。在有术前检查可用于分析病例中，4例（31%）为nTPE，3例（23%）为TPE，6例（46%）为TFE撕裂。因此，69%的患者为高级别损伤。这些患者脂肪浸润程度较高（P = 0.034），但这与术后较差的临床或影像学结果无关。1例患者因复发性损伤需要再次手术。
内镜修复后，臀中肌和臀小肌腱孤立的关节外损伤恢复情况良好。由于病例数量较少，无法观察到高级别和低级别损伤在结果上的差异。
