局部浸润麻醉下弹响髋关节镜辅助手术的疗效分析

23例(25髋)弹响髋分别在局部浸润麻醉(21髋)与椎管内麻醉(14髋)下关节镜辅助手术治疗,前者较后者手术疗效更为理想,平均手术时间更短;两者平均功能恢复时间无显著性差异,均无严重并发症发生.局部浸润麻醉下关节镜辅助手术治疗弹响髋疗效肯定.     

The snapping hip syndrome

The snapping hip syndrome is a symptom complex characterized by hip pain and an audible snapping of the hip with exercise typically seen in young individuals. "External" and "internal" etiologies have been described, although the "internal" etiology is poorly understood. A clinical, radiographic, and anatomical study of eight patients with this disorder, secondary to an internal etiology, was undertaken to aid in the diagnosis and surgical treatment. Iliopsoas bursography with cineradiography revealed subluxation of the iliopsoas tendon to be an apparent cause of the snapping hip. The anatomy of the hip in relationship to the iliopsoas tendon is defined with the anterior inferior iliac spine, iliopectineal eminence, and lesser trochanter assuming a significant role in the syndrome. An operative approach involving a partial release and lengthening of the iliopsoas tendon, with minimal resection of a lesser trochanteric bony ridge, if involved, is described.     

Efficient radiological assessment of the internal snapping hip syndrome

The aim of this study was to evaluate the diagnostic value/significance of various imaging techniques for demonstrating the underlying causative pathology of clinically suspected internal snapping hip syndrome. We intended to define the most efficient diagnostic imaging algorithm that leads to a specific definite therapy for this rare hip disorder. The imaging studies of 54 patients (43 women, 11 men, average age 58 years) with the clinical suspicion of internal snapping hip syndrome were compared for their diagnostic value/significance for finding the underlying pathology. Radiological workup included plain radiographs of the pelvis and hip joints (n=54), ultrasound (US) of the hip joints (n=29), computed tomography (CT) of the pelvis and proximal femur (n=17), and magnetic resonance imaging (MRI) of the pelvis/hip joint (n=21). In order to establish an efficient diagnostic algorithm we compared the diagnostic value of each imaging technique alone and in combination with the other methods. The underlying causative pathology could be established in 37% of patients (n=20) by the use of conventional radiographs alone and in 46% of the patients (n=25) by US alone, and in combination in 83% of the patients (n=45). By adding CT to the radiological workup, we established final diagnosis in 88% (in combination with X-ray; n=15/17) and 94% (together with X-ray and US; n=16/17) of the patients. Whenever MR imaging was used a causative pathology was found in all patients (100%; n=21). The most efficient radiological algorithm in the assessment of patients with internal snapping hip syndrome is the combination of plain radiography and US. MR imaging can be retained for unresolved and difficult cases.     

The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band

PURPOSE: A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical intervention. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band. MATERIALS AND METHODS: Nine symptomatic snapping hips in 8 consecutive patients (1 bilateral) from August 1997 through March 2002 who underwent an iliotibial band Z-plasty were reviewed. RESULTS: Eight of the 9 hips were in active-duty military and 1 was a civilian, with an average age of 25.6 years (range, 21 to 38 years). Mean duration of symptoms prior to surgical intervention was 25.2 months (range, 16 to 39 months) with an average follow-up of 22.9 months (range, 7 to 38 months). All patients had complete resolution of the snapping hip, and all but 1 returned to full unrestricted activities. The 1 failure had persistent groin pain but no residual snapping. CONCLUSIONS: Patients with snapping hip of the iliotibial band refractory to conservative treatment are rare. The surgical results of Z-plasty are excellent and predictable. Careful screening is necessary to preclude other confounding diagnoses. Z-plasty is recommended as an effective surgical treatment of the refractory snapping hip secondary to iliotibial band tightness.     

Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement

An association between hip pain and quadratus femoris MRI abnormality with concurrent narrowing of the ischiofemoral space has been reported in a number of patients to date, raising the possibility that the muscular damage observed is due to ischiofemoral impingement [1]. Possible impingement has been noted primarily in middle-aged females either with or without a history of trauma or surgery, and associated snapping of the hip is a rarely described feature [1–3]. We report here on a 17-year-old girl who presented with post-traumatic hip pain; she later developed evidence of ischiofemoral narrowing and quadratus femoris edema on MRI in addition to an audible snapping. Surgical resection of the lesser trochanter was performed, relieving both her hip pain and the snapping. To our knowledge, this is the first reported case of non-iatrogenic ischiofemoral impingement with surgical confirmation. The diagnosis of ischiofemoral impingement should be considered in patients complaining of a snapping hip.     

Low back pain associated with internal snapping hip syndrome in a competitive cyclist

Low back pain is a common complaint among cyclists. Here we present the case of a competitive master cyclist with low back pain and whose symptoms ultimately resolved when he was treated for internal snapping hip syndrome. Internal snapping hip syndrome is a painful lesion of the iliopsoas caused by snapping of the tendon over the iliopectineal eminence or anterior femoral head when the femur is extended from a flexed position. This is the first published report that we are aware of that describes this syndrome as a potential cause of low back pain in a competitive cyclist.     

Arthroscopic treatment of the painful "internal" snapping hip: results of a new endoscopic technique and imaging protocol

BACKGROUND: Traditional surgical treatment for a painful snapping iliopsoas tendon has been an open lengthening of the tendon. HYPOTHESIS: An endoscopic release will alleviate painful snapping of the tendon. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Six patients with painful snapping hips who had no pain relief after magnetic resonance arthrography, which included injection of bupivacaine into the hip joint, subsequently had an ultrasound evaluation of their iliopsoas tendons and an anesthetic injection into the psoas bursa. In all 6 patients, the injection relieved their hip pain, and in 4, real-time imaging demonstrated snapping of the tendon. All hips were evaluated with the 100-point Harris hip scoring system before and at 1.5, 3, 6, and 12 months after surgery. RESULTS: Preoperative hip scores averaged 58 points. After surgery, all patients had hip flexor weakness, used crutches for 5 weeks, and had 6-week scores that averaged 62 points. The patients continued to improve, and at 6 and 12 months, their scores averaged 90 and 96 points, respectively, and none had recurrence of their snapping or pain. CONCLUSION: Ultrasound-guided anesthetic injection of the psoas bursa is useful to confirm snapping of the iliopsoas tendon as the cause of a patient's hip pain. Endoscopic release of the tendon is a safe outpatient procedure that provides effective relief of the snapping and pain.     

Extraarticular snapping hip: sonographic findings

OBJECTIVE. The aim of the study was to determine the sonographic findings of snapping hip and to correlate the findings with the presence or absence of pain. MATERIALS AND METHODS. Twenty patients with snapping hip were examined with sonography. Conventional and dynamic sonographic examinations of both hips were performed using a 5.0- or 7.0-MHz transducer. RESULTS. Conventional sonographic studies allowed identification of various structural abnormalities (tendinitis, bursitis, synovitis) and helped to document tenderness along the course of specific tendons. Dynamic sonographic studies revealed 26 cases of snapping hip. In 24 of these 26 cases, the underlying cause was clearly identified. Twenty-two snapping hips were caused by an abnormal movement of the iliopsoas tendon, and two were caused by iliotibial band friction over the greater trochanter. One patient reported a bilateral snapping sensation that could not be documented on sonography. Snapping hip was elicited by a wide variety of hip movements. Sonography established an immediate temporal correlation between the jerky tendon motion and the painful snap reported by the patient. Only 14 cases of snapping hip were painful. CONCLUSION. Conventional sonographic studies can identify signs of tendinitis, bursitis, or synovitis. Dynamic sonographic studies revealed the cause of snapping hip in most patients. Snapping hip is characterized on sonography by a sudden abnormal displacement of the snapping structure. In our study, a significant proportion of the cases of snapping hip were not painful.     

Eccentric hip abductor weakness in patients with symptomatic external snapping hip

Symptomatic external snapping hip can be a long‐standing condition affecting physical function in younger people between 15–40 years. Gluteal weakness has been suggested to be associated with the condition. The aim of this study was to investigate whether eccentric hip abduction strength is decreased in patients with external snapping hip compared with healthy matched controls, and to examine isometric hip abduction, adduction, extension, flexion, internal rotation, and external rotation in patients with external snapping hip and matched controls. Thirteen patients with external snapping hip were compared with 13 healthy matched controls in a cross‐sectional study design. The mean age of the patients was 25.5 ± 3.4 years and the mean age of the controls was 25.6 ± 2.6 years. Eccentric and isometric strength were assessed with a handheld dynamometer, using reliable test procedures. Eccentric hip abduction strength was 16% lower in patients with external snapping hip compared with healthy matched controls (1.50 ± 0.47 Nm/kg versus 1.82 ± 0.48 Nm/kg, P = 0.01). No other strength differences were measured between patients and controls (P > 0.05). Eccentric hip abductor weakness was present in patients with symptomatic external snapping hip compared with healthy matched controls.     

全髋置换术后股骨侧假体周围骨折的手术治疗进展

股骨假体周围骨折(PFF)是全髋关节置换术(THA)后严重并发症,也是骨科医师面临的具有挑战性的难题.骨折分型对骨折的治疗有重要的指导意义,Vancouver分型不仅参考了骨折的部位,还参考了原假体的稳定性和患者股骨的质量,对术中和术后治疗方案的选择及制定都有全面的指导作用,是目前应用最广且易于接受的分型方法.该文就V...     

Surgical treatment of snapping medial hamstring tendons

Three patients were seen for pain and snapping over their medial knee during active knee flexion and extension. Physical examination revealed an audible and visible subluxation that was localized to the posteromedial aspect of their symptomatic knee. One patient underwent a semitendinosus tendon harvest, and two patients underwent a release of their semitendinosus and gracilis tendons. All three patients had normal return of function without pain or further snapping or catching events at a minimum of 2 years postoperatively.     

Temporomandibular joint arthrography following surgical treatment of internal derangements

Arthrograms of the temporomandibular joint were obtained in 20 symptomatic joints that had previous reconstructive arthroplasty with disk repositioning because of internal derangements. Preoperative arthrograms were available for comparison in 18 joints. Symptoms resulting in a postoperative arthrogram included pain, limited ability to open the mouth, and clicking of the joints. Postoperative arthrographic findings included limited anterior translation of the condyle (90%), irregularity in outline of the intraarticular contrast agent (60%), a conical configuration of the posterior recess (25%), decreased size of the joint (28%), anterior displacement of the meniscus (25%), and perforated meniscus (15%). Many of these findings may have resulted from fibrosis and scarring, which may be a response to intraarticular bleeding. The mechanism by which the fibrosis causes the postsurgical arthrographic features is discussed.     

3D打印导向模板辅助技术在髋部骨折手术中的临床研究

目的 探讨3D打印导向模板辅助技术在髋部骨折治疗中的应用价值.方法 前瞻性随机研究2017年2月—2019年2月武警河北省总队医院及河北医科大学附属医院手术治疗的髋部骨折患者60例,男性34例,女性26例;年龄35～65岁,平均52.5岁.按照随机数字表法分为3D组和常规组,各30例,3D组患者术前首先进行3D数字化重建,虚拟复位及内固定,设计导航模板等;常规组采取常规的手术方法 实施治疗.比较两组患者手术时间、手术出血量、术后引流量、术后下床活动时间、复位效果、术后不同时间髋关节功能、手术并发症.结果 3D组手术时间(73.9±8.1)min、手术出血量(230.8±30.5)mL均低于常规组(81.0±11.5)min、(285.7±46.2)mL(P<0.05);3D组和常规组术后引流量、术后下床活动时间比较差异无统计学意义(P>0.05);术后复查3D组手术复位效果优80.00％、良20.00％,常规组优56.67％、良40.00％、差3.33％,3D组优于常规组,差异有统计学意义(P<0.05);术后3个月3D组髋关节功能Harris功能评分高于常规组(P<0.05);术后6个月两组患者Harris功能评分比较差异无统计学意义(P>0.05);3D组并发症发生率6.67％(切口感染和肺部感染各1例),常规组并发症率16.67％(切口感染2例、肺部感染2例、内固定松动1例),差异无统计学意义(P>0.05).结论 3D打印导向模板手术内固定在髋部骨折治疗中可减少手术时间和出血量、提高复位效果,促进早期关节功能恢复.     

Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers

BACKGROUND: Although snapping hip syndrome is commonly reported in ballet dancers, the prevalence, impact, and underlying mechanism of this condition have not been formally studied within a cohort of dancers. PURPOSE: To determine the prevalence, associated factors, and mechanisms of snapping hip and to investigate self-reported snapping with physical and ultrasound examination. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A snapping hip questionnaire was completed by 87 unselected elite ballet dancers at 2 institutions. Twenty-six of the dancers (50 hips) who were able to voluntarily snap their hips were selected from this group for further physical examination by 2 clinicians to determine whether there was a palpable snap, and each underwent an ultrasound examination of his or her hips. RESULTS: Ninety-one percent of dancers reported snapping hip, of which most (80%) had bilateral symptoms. Fifty-eight percent had pain associated with the snap, and 7% had taken time off dance because of this condition. Sixty percent of the dancers could voluntarily snap their hip. One or more of 3 dance movements elicited the snapping in 81%. The clinicians could palpate 46 of the 50 self-reported snapping hips. Ultrasound showed a snapping iliopsoas tendon in 59% of the hips and the iliotibial band snapping in 4%. In one third of cases, ultrasound was not helpful in identifying the cause of the snapping. CONCLUSION: Snapping hip is extremely common in ballet dancers. Some dancers have significant pain, yet many are asymptomatic. Self-reported snapping is likely to be palpable by the clinician. Iliotibial band snapping is evident by physical examination and ultrasound. Iliopsoas snapping was most common and required ultrasonic confirmation.     

Surgical indications for treatment for femoroacetabular impingement with surgical hip dislocation

Purpose

There is a lack of detailed information about the indications of surgical treatment for femoroacetabular impingement (FAI), particularly using open surgical dislocation. The purpose of this review was to systematically review the reported indications for surgical dislocation of the hip for FAI.

Methods

Two databases (MEDLINE and EMBASE) were screened for clinical studies involving the treatment for FAI with surgical hip dislocation. We conducted a full-text review and the references for each included paper were hand-searched for other eligible studies. Papers published until September 2011 were included in this review. Two individuals reviewed all identified studies independently, and any disagreement was resolved through consensus.

Results

Fifteen studies met the eligibility criteria, which included a total of 822 patients. We identified a lack of consensus for clinical and radiographic indications for surgical hip dislocation to treat FAI. The most common clinical indications reported were clinical symptoms such as hip pain in 10 papers (67 %), a positive impingement sign in 9 papers (60 %), painful/reduced range of motion in 9 papers (60 %), activity-related groin pain in 4 papers (27 %), and non-responsive to non-operative treatment in 4 papers (27 %). The most commonly reported radiographic indicators for surgical hip dislocation were a variety of impingement findings from radiographs in all 15 included papers (100 %), a combination of radiographs and MRA in 5 papers (33 %) or radiographs and MRI in 3 papers (20 %).

Conclusions

These results showed that that there was an inconsistency between the clinical and radiographic indications for surgical hip dislocation as a treatment for femoroacetabular impingement. This review suggests that there is a need for the development of standardized clinical and radiological criteria that serve as guidelines for surgical treatment for FAI.

Level of evidence

Systematic review, Level IV.