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内镜治疗大转子疼痛综合征(GTPS):全面系统评价。

Endoscopic management of greater trochanteric pain syndrome (GTPS): a comprehensive systematic review.

机构信息

Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Department of Orthopaedic and Traumatology, University of Turin, Via Gianfranco Zuretti 29, 10126, Turin, Italy.

Department of Orthopaedics and Traumatology, Faculty of Medicine, Kafr El Sheikh University, Kafr El Sheikh, Egypt.

出版信息

Eur J Orthop Surg Traumatol. 2024 Aug;34(6):3385-3394. doi: 10.1007/s00590-024-04019-0. Epub 2024 Jun 11.

Abstract

BACKGROUND

Greater trochanteric pain syndrome (GTPS) presents challenges in clinical management due to its chronic nature and uncertain etiology. Historically attributed to greater trochanteric bursitis, current understanding implicates abductor tendinopathy as the primary cause. Diagnosis usually involves a clinical examination and additional tests such as imaging and provocative testing. Surgical intervention may be considered for cases refractory to conservative therapy, with endoscopic techniques gaining ground over open procedures.

MATERIALS AND METHODS

A systematic review was conducted adhering to the PRISMA guidelines. Relevant studies were searched in four databases: Pubmed, Scopus, Embase, and Medline. The selected articles were evaluated according to the criteria of levels of evidence (LoE). The Coleman methodology score (mCMS) was used to analyze the retrospective studies. This systematic review was registered in the International Prospective Registry of Systematic Reviews.

RESULTS

Surgical success rates ranged from 70.6-100%, significantly improving pain and function. Complications were generally mild, mainly hematomas and seromas, while recurrence rates were low. However, limitations such as the retrospective design and the absence of control groups warrant cautious interpretation of the results.

CONCLUSIONS

Endoscopic surgery emerges as a promising option for refractory GTPS, offering effective symptom relief and functional improvement. Despite limitations, these results suggest a favorable risk-benefit profile for endoscopic procedures. Further research is needed, particularly prospective randomized trials, to confirm these findings and optimize surgical techniques to improve patient outcomes.

摘要

背景

大转子疼痛综合征(GTPS)由于其慢性性质和不确定的病因,在临床管理中带来挑战。历史上归因于大转子滑囊炎,目前的理解暗示外展肌腱病是主要原因。诊断通常涉及临床检查和其他测试,如影像学和激发测试。对于对保守治疗无反应的病例,可能会考虑手术干预,内窥镜技术相对于开放手术有优势。

材料和方法

按照 PRISMA 指南进行了系统评价。在四个数据库中搜索了相关研究:Pubmed、Scopus、Embase 和 Medline。根据证据水平(LoE)标准评估了选定的文章。使用 Coleman 方法学评分(mCMS)分析回顾性研究。本系统评价在国际前瞻性系统评价注册库中进行了注册。

结果

手术成功率为 70.6%-100%,显著改善疼痛和功能。并发症通常较轻,主要为血肿和血清肿,而复发率较低。然而,由于回顾性设计和缺乏对照组,结果的解释需要谨慎。

结论

对于难治性 GTPS,内窥镜手术是一种很有前途的选择,可有效缓解症状和改善功能。尽管存在局限性,但这些结果表明内窥镜手术具有有利的风险效益比。需要进一步的研究,特别是前瞻性随机试验,以确认这些发现并优化手术技术,以改善患者的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fb95/11377678/37d7828d9ad0/590_2024_4019_Fig1_HTML.jpg

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