背景
髂腰肌腱炎可导致全髋关节置换术 (THA) 后持续疼痛。髂腰肌腱炎的非手术治疗包括抗炎药和图像引导皮质类固醇注射。本研究评估了超声引导下皮质类固醇注射 (US-CSI) 对全髋关节置换术后髂腰肌腱炎的疗效。
方法
我们回顾性分析了 2009 年至 2020 年间在同一机构接受初次 THA 后因髂腰肌腱炎接受 US-CSI 的 42 名患者。至少 1 年评估结果，包括再次手术、最后一次随访时的腹股沟疼痛、额外的法氏囊内注射和 Harris 髋关节评分 (HHS)。回顾交叉床侧位X光片（36名患者）或CT扫描（6名患者）以确定是否存在前杯悬垂，表明髂腰肌腱炎的机械病因。对注射前和注射后的 HHS 进行描述性统计和单变量比较，α<0.05。
结果
在 22 名没有罩杯悬垂的患者中，4 名 (18.2%) 在 US-CSI 后平均随访 40 个月（范围为 14 至 94 个月）时出现持续性腹股沟疼痛。三名患者进行了第二次注射，在最近的随访中没有人出现腹股沟疼痛。没有患者需要髋臼翻修。上次随访时，平均 HHS 从 74 分（范围 52 至 94 分）改善至 91 分（范围 76 至 100 分；p<0.001）。在 20 名患有前杯悬垂的患者中，有 5 名患者在注射暂时缓解疼痛后接受了髋臼翻修。翻修后平均随访 43 个月（范围为 12 至 60 个月），所有翻修患者的腹股沟疼痛均得到缓解。其余 15 名患者中，有 5 名患者在平均随访 35 个月时出现持续性腹股沟疼痛（范围为 12 至 83 个月）。平均 HHS 从注射前的 69 点（范围，50 至 96 点）改善至最后一次随访时的 81 点（范围，56 至 98 点；p=0.007）。
结论
该队列中 78.6% 的患者腹股沟疼痛得到缓解；然而，那些没有髋臼悬垂的人的成功率更高。总体修订率为11.9%。US-CSI 对于初次 THA 后髂腰肌腱炎的诊断和治疗似乎是安全有效的。
"点击查看英文标题和摘要"
Ultrasound-Guided Iliopsoas Bursal Injections for Management of Iliopsoas Bursitis after Total Hip Arthroplasty
Background
Iliopsoas tendonitis can cause persistent pain after total hip arthroplasty (THA). Non-operative management of iliopsoas tendonitis includes anti-inflammatories and image-guided corticosteroid injections. This study evaluated the efficacy of ultrasound-guided corticosteroid injections (US-CSIs) for iliopsoas tendonitis following THA.
Methods
We retrospectively reviewed 42 patients who received an US-CSI for iliopsoas tendonitis after primary THA between 2009 and 2020 at a single institution. Outcomes including reoperation, groin pain at last follow-up, additional intra-bursal injection, and Harris Hip Score (HHS) were evaluated at a minimum of 1 year. Cross-table lateral radiographs (36 patients) or CT scans (6 patients) were reviewed to determine if anterior cup overhang was present, indicating a mechanical etiology of iliopsoas tendonitis. Descriptive statistics and univariate comparison of HHS pre- and post-injection were performed, with alpha<0.05.
Results
Among the 22 patients who did not have cup overhang, four (18.2%) had persistent groin pain at mean follow-up of 40 months (range, 14 to 94) after US-CSI. Three patients had a second injection, none had groin pain at most recent follow-up. No patients required acetabular revision. Mean HHS improved from 74 points (range, 52 to 94 points) to 91 points (range, 76 to 100 points; p<0.001) at last follow-up. Among the 20 patients who had anterior cup overhang, five underwent acetabular revision after only temporary pain relief from injection. Groin pain was resolved in all revised patients at mean follow-up of 43 months (range, 12 to 60) after revision. Of the remaining 15 patients, five had persistent groin pain at mean follow-up of 35 months (range, 12 to 83). Mean HHS improved from 69 points (range, 50 to 96 points) pre-injection to 81 (range, 56 to 98 points; p=0.007) at last follow-up.
Conclusion
Resolution of groin pain was demonstrated in 78.6% of patients in the cohort; however, those who did not have acetabular overhang had higher rates of success. The overall revision rate was 11.9%. US-CSI appears to be safe and effective in the diagnosis and treatment of iliopsoas tendonitis following primary THA.
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