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大转子疼痛综合征的管理:一项叙述性综述。

Management of Greater Trochanteric Pain Syndrome: A Narrative Review.

作者信息

Gill Jaskiran K, Neal-Smith Gregory, Saed Abdel, Burgan Amjad, Fernquest Scott

机构信息

Trauma and Orthopedics, Queen Alexandra Hospital, Portsmouth, GBR.

Trauma and Orthopedics, Poole Hospital, Poole, GBR.

出版信息

Cureus. 2025 Jun 12;17(6):e85859. doi: 10.7759/cureus.85859. eCollection 2025 Jun.

Abstract

Greater trochanteric pain syndrome (GTPS) is characterized by pain and tenderness over the lateral aspect of the hip. It encompasses a spectrum of conditions, including abductor tendinopathy, trochanteric bursitis, and external coxa saltans. Following diagnosis, managing GTPS can be challenging due to the variability in pathology and the wide range of available treatments, many of which are supported by low levels of evidence. At present, there is no clear consensus on the optimal management approach for this condition. This review evaluates the existing literature on GTPS management, aiming to provide clinicians with a framework to guide treatment decisions. Articles were sourced from PubMed and MEDLINE using the terms "greater trochanteric pain syndrome", "trochanteric bursitis", and "gluteal tendinopathy". Findings suggest that targeted physiotherapy (PT) offers superior long-term outcomes compared to shock wave therapy and corticosteroid injections (CSI). In one study, 60.5% of patients reported symptom resolution at 15 months. Extracorporeal shock wave therapy (ESWT) demonstrated a 68.3% improvement in Visual Analogue Scale scores compared to control groups. Combining PT with CSI appears to be more effective in managing acute symptoms than PT alone. The evidence supporting platelet-rich plasma (PRP) remains inconclusive, with ongoing research needed to clarify its role. Surgical intervention is considered when conservative and medical treatments have failed, with various operative techniques showing improvements in pain scores over time. In conclusion, PT and home exercise programs have shown long-term benefits for most patients, although improvements may not be immediate. CSIs can offer short-term relief but are most effective when combined with PT for sustained benefit. Focused ESWT has limited but promising evidence supporting its use, with a low risk of adverse effects. Although PRP has shown potential in some studies, further research is necessary before it can be recommended as part of standard treatment protocols.

摘要

大转子疼痛综合征(GTPS)的特征是髋关节外侧疼痛和压痛。它涵盖一系列病症,包括外展肌肌腱病、转子滑囊炎和跳跃征。诊断后,由于病理变化的多样性和可用治疗方法的广泛存在,其中许多治疗方法的证据水平较低,管理GTPS可能具有挑战性。目前,对于这种病症的最佳管理方法尚无明确共识。本综述评估了关于GTPS管理的现有文献,旨在为临床医生提供一个指导治疗决策的框架。文章通过使用术语“大转子疼痛综合征”、“转子滑囊炎”和“臀肌肌腱病”从PubMed和MEDLINE中获取。研究结果表明,与冲击波疗法和皮质类固醇注射(CSI)相比,有针对性的物理治疗(PT)能提供更好的长期效果。在一项研究中,60.5%的患者在15个月时报告症状缓解。与对照组相比,体外冲击波疗法(ESWT)在视觉模拟量表评分上有68.3%的改善。将PT与CSI联合使用在管理急性症状方面似乎比单独使用PT更有效。支持富血小板血浆(PRP)的证据尚无定论,需要持续研究以阐明其作用。当保守治疗和药物治疗失败时考虑手术干预,各种手术技术显示随着时间推移疼痛评分有所改善。总之,PT和家庭锻炼计划对大多数患者显示出长期益处,尽管改善可能不会立即出现。CSI可提供短期缓解,但与PT联合使用时持续获益最为有效。聚焦式ESWT有有限但有前景的证据支持其使用,不良反应风险较低。尽管PRP在一些研究中显示出潜力,但在被推荐作为标准治疗方案的一部分之前还需要进一步研究。

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