METHODS: From 2008-2014, 30 consecutive patients (34 hips) with symptomatic ESHS cases refractory to conservative treatment underwent endoscopic stepwise \"fan-like\" release, gradually addressing all known reasons of ESHS: from the isolated ITB, through the fascial part of the GMC until a partial release of gluteus maximus femoral attachment occurred. Snapping was assessed intra-operatively after each surgical step and prospectively recorded. Functional outcomes were assessed via the MAHORN Hip Outcome Tool (MHOT-14).
RESULTS: Twenty seven patients (31 hips) were available to follow-up at 24-56 months. In all cases, complete snapping resolution was achieved intra-operatively: in seven cases (22.6%) after isolated ITB release, in 22 cases (70.9%), after release of ITB + fascial part of the GMC, and in two cases (6.5%) after ITB + fascial GMC release + partial release of GM femoral insertion. At follow-up, there were no snapping recurrences and MHOT-14 score significantly increased from a pre-operative average of 46 to 93(p<0.001).
CONCLUSIONS: Intraoperative identification and gradual addressing of all known causes of ESHS allows for maximum preservation of surrounding tissue during surgery while precisely targeting the directly involved structures. Endoscopic stepwise \"fan-like\" release of the ITB and GMC is an effective, tailor-made treatment option for ESHS regardless of the snapping origin in the patients with possibility to manually reproduce the snapping.
方法:从2008年至2014年,连续30例(34髋)有症状的ESHS患者对保守治疗难治性进行了内镜逐步“扇形”释放,逐步解决ESHS的所有已知原因:从孤立的ITB,通过GMC的筋膜部分,直到发生臀大肌股骨附着部分释放。每个手术步骤后的术中评估并前瞻性记录。通过MAHORN髋关节结果工具(MHOT-14)评估功能结果。
结果:27例患者(31髋)在24-56个月时可进行随访。在所有情况下,术中获得了完全的快速解决:在隔离的ITB释放后的7例(22.6%)中,22例(70.9%),ITB+GMC筋膜部分释放后,ITB+筋膜GMC松解术+GM股骨部分松解术后2例(6.5%)。在后续行动中,没有快速复发,MHOT-14评分从术前平均46分显著增加至93分(p<0.001).
结论:术中识别和逐步解决所有已知的ESHS原因,可以在手术过程中最大限度地保留周围组织,同时精确靶向直接涉及的结构。内窥镜逐步“扇形”释放ITB和GMC是一种有效的,为ESHS量身定制的治疗方案,无论患者的折断起源如何,都可以手动复制折断。