关节镜微创治疗臀深综合征疗效分析

Analysis of Therapeutic Efficacy of Arthroscopic Minimally Invasive Treatment for Deep Gluteal Syndrome

目的探究关节镜微创治疗臀深综合征(deep gluteal syndrome,DGS)的有效性及安全性,确立关节镜下DGS分型。方法回顾性分析2021年6月至2022年6月就诊于遂宁市中心医院的32例DGS患者,其中男15例,女17例;年龄24~70岁,平均(51.62±5.33)岁。记录切口数量、手术时间及术中出血量。术前、术后第1天、术后2周、术后3个月、术后6个月及术后1年采用疼痛视觉模拟评分(visual analogue scale,VAS)、改良髋关节Harris评分(Harris hip scores,HHS)、改良Benson手术结果评分及DGS评分进行疼痛、髋关节功能及满意度评价。结果所有患者均顺利完成关节镜下微创治疗手术,平均手术时间(42.36±13.27)min;术中出血量5~40 mL,平均术中出血量(8.16±17.34)mL。无一例患者术中及术后出现重要神经血管损伤并发症。术中发现DGS主要分为4种类型。患者术前VAS评分(7.52±0.64)分,改良HHS评分(56.82±3.23)分;术后第1天VAS评分(2.27±0.56)分,改良HHS评分(84.19±5.76)分,与术前比较差异均有统计学意义(P<0.05);术后6个月VAS评分(0.45±0.51)分,改良HHS评分(95.34±2.73)分,与术前比较差异均有统计学意义(P<0.05)。术后1年内随访时DGS量化评分较术前评分逐渐降低,到术后1年时≤6分达到100%,术前术后比较差异有统计学意义(P<0.05)。术后1年随访时患者满意度,优27例,良2例,可3例,优良率90.63%。结论关节镜微创治疗DGS,坐骨神经臀深间隙松解技术安全、创伤小,术后可快速彻底缓解疼痛,患者满意度高。

Objective To investigate the effectiveness and safety of arthroscopic minimally invasive treatment for deep gluteal syndrome(DGS)and establish the classification of DGS under arthroscopy.Methods A retrospective analysis was performed on 32 patients with DGS treated in the Joint Surgery Department of Suining Central Hospital from June 2021 to June 2022.The cohort comprised 15 males and 17 females,ranging in age from 24 to 70 years,with a mean age of(51.62±5.33)years.The number of incisions,surgical duration,and intraoperative blood loss were documented.Pain assessment was conducted using the visual analogue scale(VAS),while hip joint function and patient satisfaction were evaluated using the modified Harris hip score(HHS),modified Benson surgical outcome scores,and DGS scores.These evaluations were performed before surgery,on postoperative day 1,at 2 weeks,3 months,6 months,and 1 year after surgery.Results All patients successfully underwent arthroscopic minimally invasive treatment,with an average surgical duration of(42.36±13.27)minutes and intraoperative blood loss ranging from 5 to 40 mL,averaging(8.16±17.34)mL.No significant neurovascular complications were encountered during or after surgery.Intraoperatively,DGS was primarily classified into four types.Preoperatively,the VAS was(7.52±0.64),and the modified HHS was(56.82±3.23).On the first postoperative day,the VAS decreased to(2.27±0.56),and the modified HHS increased to(84.19±5.76),both showing statistically significant differences compared to preoperative scores(P<0.05).At 6 months postoperatively,the VAS further decreased to(0.45±0.51),and the modified HHS improved to(95.34±2.73),also demonstrating statistically significant differences from preoperative scores(P<0.05).During the 1-year follow-up,the DGS quantitative scores gradually declined,and at 1 year postoperatively,all cases had a score of 6 or less.Comparisons between preoperative and postoperative scores revealed statistically significant differences(P<0.05).The 1-year follow-up revealed excellent patient satisfaction in 27 cases,good in 2 cases,and fair in 3 cases,resulting in an excellent and good satisfaction rate of 90.63%.Conclusion Arthroscopic minimally invasive treatment for DGS,particularly the sciatic nerve deep gluteal space release technique,is proven to be safe with minimal trauma.It effectively and rapidly alleviates pain,resulting in high patient satisfaction rates.