Lemme Nicholas J, Dworkin Myles, Morrissey Patrick J, Testa Edward J, Kwan Daniel, Roussel Lauren, Tabaddor Ramin
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 2 Dudley Street, Providence, RI 02906, United States.
Department of Plastic Surgery, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02912, United States.
J Hip Preserv Surg. 2023 Jun 10;10(3-4):143-148. doi: 10.1093/jhps/hnad014. eCollection 2023 Aug-Dec.
Tears of the gluteus medius and minimus are an important cause of recalcitrant greater trochanteric pain syndrome. Although endoscopic and open abductor repairs have demonstrated promising outcomes, the success of these techniques is dependent on the size of the tear and the quality of the tissue. In patients presenting with abductor insufficiency and evidence of previous repair failure, large retracted tears, muscle atrophy and/or fatty infiltration, reconstruction/augmentation techniques should be considered. In the present study, we present a retrospective cohort study assessing patient outcomes following open gluteus maximus transfer for irreparable or severely retracted gluteus medius tears. Patients were included in the present study if they underwent open gluteus maximus transfer to address hip abductor tears that a senior surgeon deemed irreparable or at high risk for failure following isolated repair secondary to the following tear characteristics: large tears with >2 cm of retraction, the presence of extensive fatty infiltration (Goutallier Grade 3 or greater) and/or patients requiring revision abductor repair due to primary repair failure with associated pain and a Trendelenburg gait. Patients undergoing a concomitant, or those with a previous history of hip arthroplasty, were excluded from the study. All participants were prospectively enrolled in the study, and both pre- and post-operative patient-reported outcomes were collected at 6 months and 1 year including the modified Hip Harris Score, Visual Analog Score, Hip Outcomes Score of Activities Daily Living, Hip Outcomes Score for Sports-Related Activities and Overall Satisfaction with Hip. Pre-operative scores were compared with post-operative assessments using Student's t-test with a significance level of < 0.05. Twenty-one patients and 22 hips were included. The average age was 69 (SD ±9.2) and 17 (81%) were females. The average body mass index was 30.0 (±6.2). The outcome scores at both 6 months and 1 year demonstrated significant improvements compared with pre-operative functional assessment. This article reports the utility of gluteus medius/minimus repair augmentation or reconstruction via gluteus maximus transfer demonstrating improvement in patient-reported outcomes at short-term follow-up.
臀中肌和臀小肌撕裂是顽固性大转子疼痛综合征的重要原因。尽管内镜下和开放式外展肌修复已显示出有前景的结果，但这些技术的成功取决于撕裂的大小和组织质量。对于出现外展肌功能不全且有既往修复失败证据、大的回缩性撕裂、肌肉萎缩和/或脂肪浸润的患者，应考虑重建/增强技术。在本研究中，我们进行了一项回顾性队列研究，评估开放式臀大肌转移治疗无法修复或严重回缩的臀中肌撕裂后的患者结局。如果患者接受开放式臀大肌转移以解决髋外展肌撕裂，且高级外科医生认为该撕裂因以下撕裂特征在单纯修复后无法修复或失败风险高，则纳入本研究：回缩>2 cm的大撕裂、广泛脂肪浸润（Goutallier分级3级或更高）和/或因初次修复失败伴有疼痛和Trendelenburg步态而需要翻修外展肌修复的患者。接受同期手术的患者或有髋关节置换术既往史的患者被排除在研究之外。所有参与者均前瞻性纳入研究，并在6个月和1年时收集患者术前和术后报告的结局，包括改良的髋关节Harris评分、视觉模拟评分、日常生活活动髋关节结局评分、与运动相关活动的髋关节结局评分以及对髋关节的总体满意度。使用Student t检验将术前评分与术后评估进行比较，显著性水平<0.05。纳入21例患者和22个髋关节。平均年龄为69岁（标准差±9.2），17例（81%）为女性。平均体重指数为30.0（±6.2）。与术前功能评估相比，6个月和1年时的结局评分均有显著改善。本文报告了通过臀大肌转移进行臀中肌/臀小肌修复增强或重建的效用，显示在短期随访中患者报告的结局有所改善。
