Capurro Bruno, Kaplan Daniel J, Fenn Thomas W, Chapman Reagan S, Nho Shane J
Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, RUSH Medical College, RUSH University/RUSH University Medical Center, Chicago, Illinois, USA.
Department of Orthopedic Surgery and Traumatology, Instituto Musculoesquelético Europeo, Valencia, Spain.
Video J Sports Med. 2023 Aug 17;3(4):26350254231180629. doi: 10.1177/26350254231180629. eCollection 2023 Jul-Aug.
Gluteus medius tears are a common pathology affecting the lower extremity, predominantly in older female patients, and most often caused by chronic degenerative changes. Due to the associated morbidity with gluteus medius insufficiency, various surgical repair techniques are utilized, including open and endoscopic approaches, with equivalent biomechanical outcomes.
Open gluteus medius double-row repair with acellular allograft augmentation is indicated for patients with massive, full thickness tears, full thickness tears with extensive retraction, degenerative tears, poor tissue quality, revision cases where tendon reduction to the footprint is challenging, and impaired hip abduction strength. The primary benefit of acellular allograft use is the provision of immediate structural strength to the repair construct.
The patient is placed in the lateral decubitus position, and a direct lateral incision is made over the greater trochanter. The gluteus medius and/or minimus tendons are identified, mobilized, and provisionally reduced to the footprint. The tendon footprint is then debrided, and proximal anchors are placed. The graft is provisionally fixed to the tendon with sutures anteriorly and posteriorly to ensure correct placement. Sutures are passed from the proximal row through the tendon and prepared allograft, where 1 suture limb from each mattress is placed into a double-row anchor in the distal row. Once secured, the repair is checked through a range of dynamic positions.
Although outcomes studies are limited, case series of patients undergoing open gluteus medius repair with allograft have demonstrated favorable patient-reported outcomes, improved pain, improved hip abduction strength, and improved gait.
Open gluteus medius repair with acellular allograft provides immediate structural strength to the repair construct and should be considered in patients with massive, full thickness tears with extensive retraction, degenerative tears with poor tissue quality, revision cases, and impaired hip abduction strength.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
臀中肌撕裂是一种影响下肢的常见病理状况，主要见于老年女性患者，多由慢性退行性变引起。由于臀中肌功能不全相关的发病率，人们采用了各种手术修复技术，包括开放手术和内镜手术，其生物力学结果相当。
对于大面积全层撕裂、伴有广泛回缩的全层撕裂、退行性撕裂、组织质量差、肌腱复位至骨附着点困难的翻修病例以及髋关节外展力量受损的患者，建议采用带脱细胞异体移植物增强的开放臀中肌双排修复术。使用脱细胞异体移植物的主要益处是为修复结构提供即时的结构强度。
患者取侧卧位，在大转子上方做直接外侧切口。识别、游离臀中肌和/或臀小肌腱，并临时复位至骨附着点。然后清理骨附着点，置入近端锚钉。将移植物用缝线临时固定在肌腱的前后方，以确保正确放置。缝线从近端排穿过肌腱和制备好的异体移植物，每个褥式缝线的一个线肢置入远端排的双排锚钉中。固定后，通过一系列动态体位检查修复情况。
尽管疗效研究有限，但接受开放臀中肌异体移植修复术患者的病例系列显示，患者报告的疗效良好，疼痛减轻，髋关节外展力量增强，步态改善。
带脱细胞异体移植物的开放臀中肌修复术为修复结构提供即时的结构强度，对于大面积全层撕裂且伴有广泛回缩、组织质量差的退行性撕裂、翻修病例以及髋关节外展力量受损的患者应予以考虑。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
