髂腰肌撞击——全髋关节置换术后并发症的诊治

Iliopsoas impingement:a complication after total hip replacement

目的分析全髋关节置换术后髂腰肌撞击假体引起疼痛原因及治疗措施。方法19例人工全髋关节置换术因髂腰肌撞击髋臼假体引起髋部疼痛患者,5例采用保守治疗无效后行髂腰肌肌腱切断术12例行髂腰肌肌腱切断术,2例髋臼假体翻修。结果术后所有患者疼痛均明显减轻,Harris评分术前47～70(59±5.3)分,术后达83～95(92±1.7)分。双髋对比屈髋力量17例无明显下降,2例部分下降但并不影响髋关节功能。结论人工全髋关节置换术后因髂腰肌撞击髋臼假体引起髋部疼痛的患者,保守治疗常常效果不佳,而髂腰肌肌腱切断术效果较好。

Objective To explore the treatment of hip pain caused by iliopsoas impingment after total hip replacement. Methods 19 cases with hip pain caused by iliopsoas impingment were recruited. 5 cases were treated with conservative method first, but the result was not good, then accepted iliopsoas tenotomy, 12 cases had an initial iliopsoas tenotomy, 2 cases had an revision of the acetabular component. Results All patients had an conspious alleviation of hip pain. The Harris score was significantly better. It was 47 - 70 （ 59 ± 5.3 ） before surgery and 83 - 95 （92 ± 1.7） after surgery. Compared with the other side, the strtength of flex hip had not decreased in 17 cases, and the strength had some decreased but the major function of hip were normal in 2 cases. Conclusions Treatment of hip pain caused by iliopsoas impingment after total hip replacement with iliopsoas tenotomy should be considered when the response of conservative management is poor