Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, NY.
Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center, Shreveport, LA.
Pain Physician. 2024 Sep;27(7):435-440.
Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain that affects patients' quality of life and functioning. The condition is often associated with tightness of the iliotibial band (ITB) and tendinopathy of the gluteus medius (GMed) tendon, which are subjected to excessive stress and inflammation. A traditional treatment for GTPS is conservative medical management (CMM), which includes but is not limited to physiotherapy, oral anti-inflammatory medication, and/or local steroid injections. Surgery is performed when these treatments fail. The failure of these techniques indicates that some treatments classified as CMM may not be feasible for some patients.
This study aimed to evaluate the efficacy and safety of combined GMed and ITB injections for a cohort of CMM-refractory GTPS patients.
A retrospective chart review.
Single-center, academic hospital.
Between 01/01/2022 and 12/31/2022, a retrospective analysis of 68 hips that underwent combination GMed-ITB percutaneous ultrasound tenotomy (PUT) was performed. The primary outcome measure was a numeric rating scale (NRS) for hip pain, and the secondary outcome measures were VISA-G (Victorian Institute of Sports Assessment-Gluteal Tendinopathy) scores, sitting-to-standing and walking tolerance, and side-lying tolerance.
The patients' NRS scores decreased, and the VISA-G scores and all functional measures increased one year after the procedure, indicating significant improvement in pain and functioning (P < 0.001). Treatment success, defined as 50% reduction in pain and side-lying tolerance, was achieved by 83% of the patients. No major complications were reported.
The lack of a comparable cohort reduces the data's interpretative significance. Having a control arm would have enabled a statistical comparison between treated and untreated patients to provide a valid assessment of the procedure's benefit.
This study demonstrated the feasibility and efficacy of combined GMed-ITB PUT as a novel treatment for GTPS in patients who failed CMM. The results showed significant and durable improvement in pain, function, and quality of life at the one-year follow-up. Our study suggests that both ITB and GMed tendons are involved in the pathogenesis of GTPS. The present study compared favorably with previous studies that reported outcomes of either ITB PUT or GMed PUT alone, implying that combining the approaches may offer superior benefits. Furthermore, the study had several strengths, such as the use of a validated outcome measure (VISA-G), the elimination of bias by independent practitioners, and the inclusion of a difficult population with severe pain.
大转子疼痛综合征（GTPS）是一种常见的髋关节外侧疼痛的原因，影响患者的生活质量和功能。这种情况通常与阔筋膜张肌（ITB）紧张和臀中肌（GMed）肌腱病有关，这些组织会受到过度的压力和炎症。GTPS 的传统治疗方法是保守医学管理（CMM），包括但不限于物理治疗、口服抗炎药和/或局部皮质类固醇注射。当这些治疗方法失败时，会进行手术。这些技术的失败表明，一些被归类为 CMM 的治疗方法可能对某些患者不可行。
本研究旨在评估联合 GMed 和 ITB 注射治疗 CMM 难治性 GTPS 患者的疗效和安全性。
回顾性图表审查。
单中心，学术医院。
在 2022 年 1 月 1 日至 12 月 31 日期间，对 68 髋接受联合 GMed-ITB 经皮超声肌腱切开术（PUT）的患者进行回顾性分析。主要结局测量指标是髋关节疼痛的数字评定量表（NRS），次要结局测量指标是 VISA-G（维多利亚运动评估-臀肌肌腱病）评分、坐立-站立和行走耐受性以及侧卧位耐受性。
患者的 NRS 评分下降，VISA-G 评分和所有功能测量值在手术后一年增加，表明疼痛和功能明显改善（P<0.001）。83%的患者达到了治疗成功的标准，即疼痛减轻 50%，侧卧位耐受性提高。没有出现重大并发症。
缺乏可比的队列降低了数据的解释意义。如果有对照组，就可以在治疗组和未治疗组之间进行统计学比较，从而对该手术的益处进行有效评估。
本研究证明了联合 GMed-ITB PUT 作为 CMM 治疗失败的 GTPS 患者的一种新治疗方法是可行和有效的。结果显示，在一年的随访中，疼痛、功能和生活质量有显著和持久的改善。我们的研究表明，ITB 和 GMed 肌腱都参与了 GTPS 的发病机制。本研究与单独进行 ITB PUT 或 GMed PUT 的研究结果进行了比较，结果表明联合治疗可能具有更好的优势。此外，该研究还具有一些优势，如使用了经过验证的结局测量指标（VISA-G）、通过独立医生消除了偏倚以及纳入了疼痛剧烈的困难人群。
