Center for Musculoskeletal Surgery, Charité University Hospital Berlin, Luisenstraße 64, 10117, Berlin, Germany.
Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria.
Arch Orthop Trauma Surg. 2024 Jul;144(7):3063-3071. doi: 10.1007/s00402-024-05417-z. Epub 2024 Jul 3.
To evaluate the function of the abductor mechanism after a gluteus maximus flap transfer due to a degeneration of the muscles after hip arthroplasty, we analyzed the post-operative functional outcome as well as radiographic effects in muscle tissue.
This present study included six consecutive patients operatively treated with a gluteus maximus flap due to chronic gluteal deficiency after total hip arthroplasty. All patients presented a preoperative severe limp, hip abductor deficiency and a history of conservative treatment without the relief of symptoms. MRI scans were performed pre- and postoperatively to evaluate the muscle volume and grade of degeneration of the abductor mechanism. For clinical evaluation, the Harris hip score (HHS) was applied pre- and postoperatively. Moreover, the intensity of pain, the Trendelenburg sign, the internal rotation lag sign and the abductor muscle force were measured before and after surgery.
Overall, the evaluation of the Magnetic Resonance Imaging (MRI) showed no significant changes in total muscle volume during the follow-up period. Separate measurements presented a significant growth of muscle volume for the gluteus minimus and tensor fascia lata compared to preoperative imaging during the follow-up period. The amount of fat volume decreased for all the measured muscles with statistical significance for the gluteus minimus, the gluteus medius and the tensor fascia lata. No further muscle degeneration and no flap necrosis were measured. The postoperative HHS results were not statistically significant compared to the preoperative results.
Besides fair clinical results, the radiological measurements indicate that the flap transfer enables functional muscular tissue recovery and prevents further degeneration. Given these conditions, the gluteus maximus muscle flap transfer represents a viable treatment option for patients with chronic gluteal deficiency in selected patients.
为了评估髋关节置换术后因肌肉退行性变导致臀大肌瓣转移后的外展机制功能，我们分析了术后功能结果以及肌肉组织的放射学效应。
本研究纳入了 6 例连续接受臀大肌瓣转移手术治疗的患者，这些患者均因全髋关节置换术后慢性臀肌缺陷。所有患者术前均存在严重跛行、髋外展肌缺陷和保守治疗史，但症状未缓解。术前和术后均行 MRI 扫描评估外展机制的肌肉体积和退行性变程度。临床评估采用 Harris 髋关节评分（HHS）。此外，术前和术后均测量疼痛强度、单腿站立试验、内旋滞后征和外展肌力量。
总体而言，磁共振成像（MRI）评估显示，在随访期间，总肌肉体积没有明显变化。单独测量显示，在随访期间，臀小肌和阔筋膜张肌的肌肉体积与术前相比有显著增长。所有测量肌肉的脂肪量均减少，臀小肌、臀中肌和阔筋膜张肌的减少量具有统计学意义。未测量到进一步的肌肉退行性变和皮瓣坏死。与术前相比，术后 HHS 结果无统计学意义。
除了良好的临床结果外，放射学测量表明皮瓣转移可实现功能性肌肉组织恢复并防止进一步退行性变。鉴于这些情况，对于选择的慢性臀肌缺陷患者，臀大肌肌瓣转移是一种可行的治疗选择。
