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阔筋膜张肌转移双排髋外展肌重建术治疗髋关节置换术后严重臀中肌步态

Double Row Hip Abductor Reconstruction with Fasciae Latae Transfer for Severe Trendelenburg after Hip Arthroplasty.

作者信息

Capurro-Soler Bruno, Pizarro-Geraldo Wilson, Badillo-Pérez Eduardo, González-Vonder Meden Sebastián, Rivera-Mora Omar, García-Salas Emerson, Vecchi Francesco, Arguelles Aldo

机构信息

Department of Orthopedics and Sports Traumatology, Hospital Ribera IMSKE-European Musculoskeletal Institute, 46024 Valencia, Spain.

Iberian Group of Hip Preservation Surgery (GIPCA), 4249-004 Porto, Portugal.

出版信息

J Clin Med. 2024 Oct 7;13(19):5964. doi: 10.3390/jcm13195964.

Abstract

: Tendinopathy of the gluteus medius and minimus tendons is a primary source of lateral hip pain, ranging from interstitial and partial-thickness tears to complete tears. Treatments include muscle transfers, Achilles tendon allograft procedures, and primary repairs with allografts. This study evaluated the one-year outcomes of gluteus medius and minimus reconstruction using an open double-row technique with a partial tensor fasciae latae transfer for severe Trendelenburg post-total hip arthroplasty. A prospective study involving eight patients who underwent surgery from April to December 2023 was conducted. The surgery involved an open technique with double-row suture reinforcement and tensor fasciae latae autograft. Outcomes were measured using strength, the Harris Hip Score (HHS), 12-Item Short Form Health Survey (SF-12), Hip Outcome Tool (HOT), International Hip Outcome Tool (iHOT), and Visual Analog Scale (VAS). Follow-ups occurred at 1, 3, 6, 9, and 12 months postoperatively. At an average follow-up of 7.17 months, significant improvements in both hip function and quality of life were observed. The SF-12 quality of life score increased from 27 preoperatively to 34 by month 12. Hip functionality, as measured by the HHS, showed a marked improvement from 48 to 94 points, particularly after six months. The HOT score for hip functionality rose by 23 points by the third month, reaching an average of 86 points. Similarly, the iHOT score increased from 20 to 83 points starting at month 3, reflecting substantial improvements in hip function. Statistically significant improvements were noted at as early as month 3 ( = 0.02), with highly significant gains by month 6 ( < 0.01), which remained stable through month 12 ( < 0.01). Reconstruction of the gluteus medius and minimus tendons using an open double-row technique with a partial tensor fasciae latae transfer significantly enhances hip function and quality of life. Over an average follow-up period of 7.17 months, patients experienced notable improvements. This technique is an effective option for treating lateral hip pain due to tendinopathy.

摘要

臀中肌和臀小肌腱病是髋部外侧疼痛的主要原因,范围从间质和部分厚度撕裂到完全撕裂。治疗方法包括肌肉转移、跟腱同种异体移植手术以及同种异体移植的初次修复。本研究评估了采用开放双排技术并部分转移阔筋膜张肌治疗全髋关节置换术后严重Trendelenburg步态的臀中肌和臀小肌重建的一年疗效。进行了一项前瞻性研究,纳入了2023年4月至12月接受手术的8名患者。手术采用开放技术,进行双排缝线加强和阔筋膜张肌自体移植。使用力量、Harris髋关节评分(HHS)、12项简短健康调查(SF - 12)、髋关节结局工具(HOT)、国际髋关节结局工具(iHOT)和视觉模拟量表(VAS)来测量结果。术后1、3、6、9和12个月进行随访。在平均7.17个月的随访中,观察到髋关节功能和生活质量均有显著改善。SF - 12生活质量评分从术前的27分提高到术后12个月的34分。以HHS衡量的髋关节功能从48分显著提高到94分,尤其是在六个月后。髋关节功能的HOT评分到第三个月提高了23分,平均达到86分。同样,iHOT评分从第三个月开始从20分增加到83分,反映出髋关节功能有实质性改善。早在第三个月就观察到统计学上的显著改善( = 0.02),到第六个月有高度显著的改善( < 0.01),并一直稳定到12个月( < 0.01)。采用开放双排技术并部分转移阔筋膜张肌重建臀中肌和臀小肌腱可显著提高髋关节功能和生活质量。在平均7.17个月的随访期内,患者有明显改善。该技术是治疗肌腱病引起的髋部外侧疼痛的有效选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99dc/11477932/f46ce78bef87/jcm-13-05964-g001.jpg

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