PDF(Pubmed)
Abstract：
OBJECTIVE: To evaluate the current evidence and literature on treatment options for proximal hamstring injuries.
RESULTS: Patients with 3-tendon complete tears with greater than 2 cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.
RESULTS: Patients with 3-tendon complete tears with greater than 2 cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.
摘要：
目的：评估目前关于近端腿筋损伤治疗方案的证据和文献。
结果：与严重损伤程度较低的患者相比，回缩大于2cm的3肌腱完全撕裂患者的预后更差，并发症发生率更高。在5年的随访中，内镜和开放性近端腿筋修复均具有良好的患者报告结果。男性患者的近端腿筋修复，孤立的半膜损伤，并且有腿筋近端游离肌腱断裂的人更有可能有较早的恢复运动。巴黎腿筋撕脱评分（PHAS）是经过验证的患者报告的结果指标，可预测恢复运动。近端腿筋损伤可能发生在精英和休闲运动员中，并且可能表现出不同程度的慢性和严重程度。损伤最常见于腿筋的强力偏心收缩，常伴有坐骨结节压痛。瘀斑,和腿筋无力。治疗决策取决于所涉及的肌腱和慢性性。许多近端腿筋损伤可以通过非手术措施成功治疗。然而,与非手术治疗相比,适当的手术治疗表明近端腿筋肌腱损伤可导致明显更好的功能结局,并更快、更可靠地恢复运动.内窥镜和开放手术修复技术在短期和中期随访中均显示出较高的满意度和出色的患者报告结果。术后康复方案因文献而异，需要进行研究以阐明最佳方案。虽然强调偏心腿筋加强可能是有益的。
结果：与严重损伤程度较低的患者相比，回缩大于2cm的3肌腱完全撕裂患者的预后更差，并发症发生率更高。在5年的随访中，内镜和开放性近端腿筋修复均具有良好的患者报告结果。男性患者的近端腿筋修复，孤立的半膜损伤，并且有腿筋近端游离肌腱断裂的人更有可能有较早的恢复运动。巴黎腿筋撕脱评分（PHAS）是经过验证的患者报告的结果指标，可预测恢复运动。近端腿筋损伤可能发生在精英和休闲运动员中，并且可能表现出不同程度的慢性和严重程度。损伤最常见于腿筋的强力偏心收缩，常伴有坐骨结节压痛。瘀斑,和腿筋无力。治疗决策取决于所涉及的肌腱和慢性性。许多近端腿筋损伤可以通过非手术措施成功治疗。然而,与非手术治疗相比,适当的手术治疗表明近端腿筋肌腱损伤可导致明显更好的功能结局,并更快、更可靠地恢复运动.内窥镜和开放手术修复技术在短期和中期随访中均显示出较高的满意度和出色的患者报告结果。术后康复方案因文献而异，需要进行研究以阐明最佳方案。虽然强调偏心腿筋加强可能是有益的。
