Preservation technique of the piriformis tendon is superior to reattachment technique in terms of contiguity and muscle atrophy: using magnetic resonance imaging
Preservation technique of the piriformis tendon is superior to reattachment technique in terms of contiguity and muscle atrophy: using magnetic resonance imaging
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DOI：
10.1177/1120700017752565
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发表时间：
2018-11-01
影响因子：
1.5
通讯作者：
Yamamoto, Takuaki
中科院分区：
文献类型：
--
作者：
Minokawa, So;Naito, Masatoshi;Yamamoto, Takuaki
目的：在全髋关节置换术中，后外侧入路保留梨状肌腱的方法在脱位方面优于再附着法。然而，在全髋关节置换术中保留梨状肌腱的长期效果尚不清楚。在这项研究中，我们使用磁共振成像(MRI)来评估梨状肌/连合肌腱的邻接性和梨状肌/内闭孔肌萎缩的情况。方法：我们回顾了48例有MRI资料的患者。将48例患者分为保留梨状肌腱的P组(n=29)和切断梨状肌后再附着的R组(n=19)。平均随访时间为45.9个月。所有患者均观察梨状肌/连合肌腱的毗邻情况及梨状肌/内闭孔肌萎缩情况。结果：P组和R组的梨状肌腱均附着于大转子，占68.4%。梨状肌萎缩率P组为15.9%+/-21.1%，R组为41.6%+/-19.1%(P<；0.001)。联合肌腱修复完好率分别为72.4%和36.8%(P<；0.05)。P组平均内闭孔肌萎缩率为31.4%+/-26.2%，R组为50.4%+/-19.1%(P<；0.05)。术后无肺栓塞、伤口感染、深部感染、髋关节脱位等并发症发生。结论：在本研究中，梨状肌腱的保留技术在邻接性和肌肉萎缩方面优于再附着术。
Purpose: The preservation technique of the piriformis tendon during the posterolateral approach in total hip arthroplasty (THA) is reportedly superior to the reattachment technique in terms of dislocation. However, the long-term effects of preservation of the piriformis tendon during THA remain unknown. In this study, we evaluated the contiguity of the piriformis/conjoined tendon and atrophy of the piriformis/internal obturator muscle during a long-term postoperative follow-up using magnetic resonance imaging (MRI).Methods: We retrospectively evaluated 48 patients with available MRI. The 48 patients were classified into a P group (n = 29), in which the piriformis tendon was preserved, and an R group (n = 19), in which the piriformis was reattached after sectioning. The mean follow-up duration was 45.9 months. The contiguity of the piriformis/conjoined tendon and atrophy of the piriformis/internal obturator muscle were evaluated in all patients.Results: The piriformis tendon remained attached to the greater trochanter in all P-group patients and 68.4% of R-group patients. The mean piriformis muscle atrophy ratios were 15.9% +/- 21.1% in the P group and 41.6% +/- 19.1% in the R group (p < 0.001). The conjoined tendon repair remained intact in 72.4% of P-group patients and 36.8% of R-group patients (p < 0.05). The mean internal obturator muscle atrophy ratio was 31.4% +/- 26.2% in the P group and 50.4% +/- 19.1% in the R group (p < 0.05). No postoperative pulmonary embolism, wound infection, deep infection, or hip dislocation occurred.Conclusions: In our study, we suggest that the preservation technique of the piriformis tendon is superior to the reattachment technique in terms of contiguity and muscle atrophy.