PDF(Pubmed)
Abstract：
OBJECTIVE: External snapping hip syndrome (ESHS) was historically attributed to isolated iliotibial band (ITB) contracture. However, the gluteus maximus complex (GMC) may also be involved. This study aimed to intraoperatively identify the ESHS origin and assess the outcomes of endoscopic treatment based on the identified aetiological type.
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.
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.
摘要：
目的：髋关节外折断综合征（ESHS）历史上可归因于孤立的髂胫带（ITB）挛缩。然而,也可能涉及臀大肌复合体（GMC）。本研究旨在在术中确定ESHS的起源，并根据确定的病因类型评估内镜治疗的结果。
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。
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。
