大转子疼痛综合征:解剖、病理、鉴别诊断及治疗  

Greater trochanter pain syndrome:anatomy,pathology,differential diagnosis and treatment

作　　者：张超[1] 吕欣[1] 刘晋元[1] 王小虎[1] 许晓沛 刘泽民[1] Zhang Chao;Lü Xin;Liu Jinyuan;Wang Xiaohu;Xu Xiaopei;Liu Zemin(Department of Orthopedics,The Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2022年第2期296-301,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:大转子疼痛综合征指由于股骨大转子周围的组织结构发生损伤或病理改变,从而导致髋关节外侧疼痛的一系列转子周围间隙疾病的总称,虽然非类固醇类抗炎药、皮质类固醇注射和物理治疗对大多数患者有效,但有相当数量的患者仍然存在髋关节疼痛及功能受限。目的:通过对近几年大转子疼痛综合征的解剖、病因、诊断及治疗的相关文献进行归纳总结,为临床认识及治疗大转子疼痛综合征提供依据。方法:通过计算机检索MEDLINE(通过PubMed)和Embase数据库,检索词为"greater trochanteric pain syndrome,anatomy,etiology,diagnosis,imaging,treatment,surgical"。依据纳入标准与排除标准,最终选入相关文献59篇,对其进行归纳总结。结果与结论:大转子疼痛综合征的病因包括大转子滑囊炎、外展肌腱腱索病(臀中肌和臀小肌撕裂)以及髂胫束摩擦综合征,目前研究表明外展肌腱腱索病是疼痛的主要原因。因此,非类固醇类抗炎药的疗效可能有限;而其他的非手术治疗方法,如家庭锻炼、体外冲击波疗法以及富血小板血浆则显现出更好的疗效,非手术方法是治疗大转子疼痛综合征的主要方法;对于非手术治疗效果不佳的患者,常规切开式或髋关节镜手术治疗已显示出希望。BACKGROUND:Greater trochanter pain syndrome indicates a series of peritrochanteric space diseases that cause pain on the lateral side of the hip joint due to damage or pathological changes in the tissue structure around the greater trochanter of the femur.Although nonsteroidal anti-inflammatory drugs,corticosteroid injections,and physical therapy are effective in most patients,a significant number of patients still experience hip pain and functional limitations.OBJECTIVE:To review the literature related to the anatomy,etiology,diagnosis and treatment of great trochanteric pain syndrome in recent years,providing evidence for clinical understanding and treatment of great trochanteric pain syndrome.METHODS:The databases of Medline and Embase were searched by compute using the keywords of"greater trochanteric pain syndrome,anatomy,etiology,diagnosis,imaging,treatment,surgical"in English.As per the inclusion criteria and exclusion criteria,59 related literatures were finally included and summarized.RESULTS AND CONCLUSION:Greater trochanteric pain syndrome encompasses trochanteric bursitis,abductor tendinopathy(gluteus medius and gluteus minimus tendinopathy),and lliotibial tract friction syndrome.Abductor tendinopathy has been shown to be a major cause of pain.As a result,the efficacy of nonsteroidal anti-inflammatory drugs may be limited,while other non-surgical treatments,such as home exercise,extracorporeal shock wave therapy,and platelet-rich plasma,appear to be more effective.Non-surgical methods are the primary treatment for greater trochanteric pain syndrome.Open and endoscopic treatment options are available when nonsurgical treatment is unsuccessful.

关 键 词：大转子疼痛综合征 转子滑囊炎 外展肌肌腱腱索病 髂胫束摩擦综合征 MRI 治疗 综述 

分 类 号：R459.9[医药卫生—治疗学] R496[医药卫生—临床医学]