摘要
目的 分析关节镜下经大转子周围间隙横向松解髂胫束治疗外侧弹响髋的临床疗效.方法 回顾性分析2021年5月至2022年6月于解放军总医院第四医学中心骨科医学部运动医学科接受关节镜下经大转子周围间隙横向松解髂胫束治疗的双侧外侧弹响髋患者30例(大转子周围间隙组),男12例、女18例,年龄(32.5±8.2)岁(范围17～51岁).选取同期接受关节镜下经髂胫束外表面横向松解髂胫束(髂胫束外表面组)的30例患者作对照,男13例、女17例,年龄(29.5±6.8)岁(范围11～45岁).比较两组患者术前、术后6个月和末次随访时的疼痛视觉模拟评分(visual analogue scale,VAS)、改良 Harris髋关节评分(modified Harris hip score,mHHS)、臀肌挛缩症功能量化评分(gluteal muscle contracture dis-ability scale,GDS).结果 所有患者均顺利完成手术并获得随访,随访时间为(17.5±3.3)个月(范围12～25个月).两组患者末次随访的VAS评分均小于术前,差异有统计学意义(P＜0.05).大转子周围间隙组术前、术后6个月和末次随访的mHHS 评分分别为[76.5(67.0,85.5)]分、[98.5(94.8,100.0)]分、[100.0(97.0,100.0)]分,髂胫束外表面组分别为[80.5(70.0,86.0)]分、[100.0(96.0,100.0)]分、[100.0(99.5,100.0)]分.两组患者mHHS评分组内比较的差异均有统计学意义(P＜0.05);其中术后6个月和末次随访均大于术前,差异有统计学意义(P＜0.05);术后6个月和末次随访的差异无统计学意义(P＞0.05).不同时间点mHHS评分组间比较的差异均无统计学意义(P＞0.05).大转子周围间隙组术前、术后6个月和末次随访的GDS分别为[47.0(35.8,64.5)]分、[90.0(81.0,94.0)]分、[93.5(89.8,98.0)]分,髂胫束外表面组分别为[51.0(38.0,60.8)]分、[90.0(84.0,94.3)]分、[93.5(89.0,96.0)]分.两组患者GDS评分组内比较的差异均有统计学意义(P＜0.05);其中术后6个月和末次随访均大于术前,差异有统计学意义(P＜0.05);术后6个月和末次随访的差异无统计学意义(P＞0.05).不同时间点GDS组间比较的差异均无统计学意义(P＞0.05).结论 关节镜下经大转子周围间隙横向松解髂胫束治疗外侧弹响髋可有效减轻髋部疼痛、改善髋关节功能,临床效果满意,可作为经髂胫束外表面横向松解的一种替代治疗.
Abstract
Objective To analyze the clinical efficacy of arthroscopic transverse release of the iliotibial band through peritrochanteric space for the treatment of external snapping hip.Methods A total of 30 patients(12 males and 18 females)with bilateral external snapping hip underwent arthroscopic transverse release of the iliotibial band through peritrochanteric space in Department of Sports Medicine,Senior Department of Orthopaedics,the Fourth Medical Center,Chinese PLA General Hospital were retrospectively analyzed from May 2021 and June 2022.The average age was 32.5±8.2 years(range,17-51 years).At the same time,30 patients who underwent arthroscopic external release of the iliotibial band through the external surface of the iliotibi-al hand(external iliotibial band group)were selected as control group,including 13 males and 17 females,aged 29.5±6.8 years(range,11-45 years).The visual analogue scale(VAS),modified Harris hip score(mHHS),and gluteal muscle contracture disabili-ty scale(GDS)were compared between the two groups at preoperative,6 months postoperative,and final follow-up.Results All patients successfully completed the operation and were followed up for 17.5±3.3 months(range,12-25 months).The VAS scores of the two groups at the last follow-up were lower than those before operation(P＜0.05).The mHHS scores before operation,6 months after operation and at the last follow-up in the peritrochanteric space group were 76.5(67.0,85.5),98.5(94.8,100.0)and 100.0(97.0,100.0),respectively,and those in the external iliotibial band group were 80.5(70.0,86.0),100.0(96.0,100.0)and 100.0(99.5,100.0).The differences in mHHS scores between the two groups were statistically significant for intragroup compari-sons(P＜0.05);of these,6 months postoperatively and at the last follow-up were greater than preoperatively,with statistically signif-icant differences(P＜0.05);the differences at 6 months postoperatively and at the last follow-up were not statistically significant(P＞0.05).There was no significant difference in mHHS scores between groups at different time points(P＞0.05).The GDS before operation,at 6 months after operation and at the last follow-up were 47.0(35.8,64.5),90.0(81.0,94.0)and 93.5(89.8,98.0)in the peritrochanteric space group,and 51.0(38.0,64.5),50.0(81.0,94.0)and 93.5(89.8,98.0)in the external iliotibial band group,respectively.The differences in GDS between the two groups were statistically significant for intragroup comparisons(P＜0.05);of these,6 months postoperatively and at the last follow-up were greater than preoperatively,with statistically significant dif-ferences(P＜0.05);the differences at 6 months postoperatively and at the last follow-up were not statistically significant(P＞0.05).There was no significant difference in GDS between groups at different time points(P＞0.05).Conclusion Arthroscopic trans-verse release of the iliotibial band through peritrochanteric space for the treatment of external snapping hip can effectively reduce hip pain and improve hip function,with satisfactory clinical results,and can be used as an alternative treatment to transverse re-lease through the external surface of the iliotibial band.
NETL
NSTL
维普
万方数据