Risk factors and progress in diagnosis and treatment of iliopsoas impingement after total hip replacement
朱洪勋 1吕济娟 1张鹏 1冯志 1叶青合1
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 山东省临沂市人民医院骨科,临沂 276000
折叠
摘要
全髋关节置换术(total hip arthroplasty,THA)是日臻成熟的骨科手术,虽然具有良好的远期生存率,但仍会出现术后疼痛、感染和松动等问题,尤其是腹股沟疼痛.髂腰肌撞击是导致THA术后腹股沟疼痛相对少见且极易被忽略的原因,由于对其认识不足,常会出现诊断延误和治疗不当的情况.髂腰肌撞击指髂腰肌与髋臼前方异常接触而产生的腹股沟区疼痛.THA术后发生髂腰肌撞击有许多危险因素,如髋臼杯突出、骨赘撞击、螺钉突出、骨水泥外溢、髋臼假体位置不当、下肢长度变化等.髂腰肌撞击的诊断主要依据体格检查、影像学征象和一种诊断性治疗,即在透视或超声引导下髂腰肌腱鞘内注射皮质类固醇和局麻药物后疼痛缓解.诊断髂腰肌撞击时需排除髋关节脱位、假体周围感染、松动或骨折等原因.治疗髂腰肌撞击可采用非手术治疗(包括非甾体类抗炎药、物理治疗及超声引导下髂腰肌腱鞘内注射皮质类固醇和局麻药物)、髂腰肌肌腱切断术和髋臼杯翻修术,为使患者获益最大化,这三种治疗方法应阶梯式进行.
Abstract
Total hip arthroplasty(THA)is a progressively refined orthopaedic surgery with excellent long-term survival rates,but it still faces problems such as postoperative pain,infection and loosening,especially groin pain.Iliopsoas impingement(IPI)is a relatively rare and overlooked cause of groin pain after THA,which often leads to delayed diagnosis and inappropriate treatment due to lack of awareness.IPI refers to the pain in the groin area caused by abnormal contact between the iliopsoas and the front of the acetabulum.There are many risk factors for IPI after THA including acetabular cup protrusion,osteophyte impinge-ment,screw protrusion,bone cement extravasation,improper placement of acetabular prosthesis,and changes in lower limb length.The diagnosis of IPI is primarily based on physical examination,imaging findings,and a diagnostic treatment of pain relief follow-ing fluoroscopic or ultrasound-guided injection of corticosteroids and local anesthesia into the iliopsoas tendon sheath.Other poten-tial causes such as hip dislocation,periprosthetic infection,loosening or fracture should be excluded.Treatment of IPI includes non-surgical treatment(non-steroidal anti-inflammatory drugs,physical therapy and ultrasound-guided injections of corticosteroids and local anesthesia in the iliopsoas tendon sheath),iliopsoas tenotomy,and acetabular cup revision,all three of which should be per-formed stepwise to maximize patient benefit.
万方数据