背景:髂腰肌(IP)肌肉萎缩是开放性IP肌腱切开术的已知结果,但关节镜下唇水平IP肌腱切开术后发生IP肌萎缩的严重程度尚未记录.
目的:为了记录髂关节肌肉萎缩的严重程度,腰大肌,关节镜下唇水平IP肌腱切开术后的髋关节肌肉。
方法:案例系列;证据水平,4.
方法:本报告以28例患者为基础,这些患者在关节镜下唇水平IP肌腱切开术前和术后3个月至5年进行了磁共振关节造影(MRA)检查。2名肌肉骨骼放射科医师一致检查了每位患者的术前和术后MRA,他们将术后肌肉萎缩从0(无脂肪浸润)分级为4(>75%脂肪浸润),并注意到任何代偿性肌肉肥大或IP肌腱形态异常。术前和术后MRA时,还使用Byrd100点改良的HarrisHip评分系统(MHHS)对患者进行了评估。
结果:术后MRA平均获得1.7年(范围,髋关节镜检查后3个月至5年)。所有患者术前MRA均无肌肉萎缩。相比之下,89%的患者在术后MRA上有髂和腰大肌萎缩,但只有2人(7%)发展为4级萎缩,大多数(64%)患有1级(n=15)或无萎缩(n=3)。此外,轻度(0-1级)患者的MHHS没有显着差异,中等(2-3年级),或严重(4级)术后萎缩。术后MRA还显示股方肌(n=5)和股直肌(n=1)低度萎缩(1-2级),16例患者(57%)肌腱变形,但他们的肌腱都没有缺口.
结论:大多数患者(89%)在关节镜下进行唇水平IP肌腱切开术后出现IP肌肉萎缩,尽管这一百分比与小转子IP肌腱切开术报告的百分比相似(89%vs90%),患者没有(1)发展臀大肌和股外侧肌萎缩,(2)有慢性IP肌腱断裂,或(3)发展的IP萎缩的严重程度(55%4级和7%4级),在关节镜下小转子IP肌腱切除术后已报道。
BACKGROUND: Iliopsoas (IP) muscle atrophy is a known consequence of open IP tenotomy, but the severity of IP muscle atrophy that occurs after arthroscopic labral-level IP tenotomies has not been documented.
OBJECTIVE: To document the severity of muscle atrophy that occurs in the iliacus, psoas, and adjacent hip musculature after arthroscopic labral-level IP tenotomy.
METHODS: Case series; Level of evidence, 4.
METHODS: Twenty-eight patients who had magnetic resonance arthrograms (MRAs) obtained prior to and 3 months to 5 years after arthroscopic labral-level IP tenotomies are the basis of this report. The pre- and postoperative MRAs of each patient were examined in consensus by 2 musculoskeletal radiologists who graded the postoperative muscle atrophy from 0 (no fatty infiltration) to 4 (>75% fatty infiltration) and noted any compensatory muscle hypertrophy or abnormal IP tendon morphology. Patients also were assessed with the Byrd 100-point modified Harris Hip Scoring system (MHHS) preoperatively and at the time of their postoperative MRA.
RESULTS: Postoperative MRAs were obtained on average 1.7 years (range, 3 months to 5 years) after hip arthroscopy. None of the patients had muscle atrophy on their preoperative MRAs. In contrast, 89% of patients had iliacus and psoas muscle atrophy on their postoperative MRAs, but only 2 (7%) developed grade 4 atrophy, and the majority (64%) had either grade 1 (n = 15) or no atrophy (n = 3). In addition, there were no significant differences in the MHHS of the patients with mild (grades 0-1), moderate (grades 2-3), or severe (grade 4) postoperative atrophy. Postoperative MRAs also demonstrated low-grade atrophy (grades 1-2) in the quadratus femoris (n = 5) and rectus femoris (n = 1) muscles, and 16 patients (57%) had distortion of the tendon, but none had a gap in their tendon.
CONCLUSIONS: A majority of patients (89%) developed IP muscle atrophy after arthroscopic labral-level IP tenotomies, and although this percentage was similar (89% vs 90%) to that reported with lesser trochanteric IP tenotomies, the patients did not (1) develop atrophy of the gluteus maximus and vastus lateralis muscles, (2) have chronic IP tendon disruption, or (3) develop the severity of IP atrophy (55% grade 4 vs 7% grade 4) that has been reported after arthroscopic lesser trochanteric IP tenotomies.