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Avulsionsverletzungen des M. glutaeus medius und M. glutaeus minimus

Avulsion injuries of the gluteus medius and gluteus minimus muscles

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Zusammenfassung

Avulsionsverletzungen des M. glutaeus medius und M. glutaeus minimus stellen eine diagnostische und therapeutische Herausforderung dar. Selten ist nach Hochrasanztraumen mit derartigen Verletzungen zu rechnen. Häufiger sind degenerative Vor- bzw. iatrogene Schäden im Rahmen von hüftchirurgischen Eingriffen als Ursache zu erkennen. Klinisch zeigt sich neben seitlichen Hüftschmerzen ein Insuffizienzhinken bei entsprechender Ausdehnung des Sehnenschadens. Diagnostisch wegweisend sind neben der Anamnese und klinischen Untersuchung die bildgebende Untersuchung mithilfe der Sonographie und v. a. Magnetresonanztomographie (ggf. mit artefaktreduzierten Sequenzen bei einliegender Endoprothese). Therapeutisch ist ein schrittweises Vorgehen in Abhängigkeit von Rupturausmaß und Qualität des glutäalen Sehnen- und Muskelgewebes angezeigt. Spezifische konservative Trainingsregime, „Mini-open“-/endoskopische anatomische Rekonstruktionstechniken bei Integrität der Glutäalmuskulatur und Muskeltransferplastiken als „Salvage“-Lösung bei chronischer Massenruptur stehen zur Auswahl. Gemeinsames Ziel ist die Wiederherstellung der Berufs- und Alltagsmobilität zur Wiedergewinnung der Lebensqualität.

Abstract

Avulsion injuries of the gluteus medius and gluteus minimus muscles represent a diagnostic and therapeutic challenge. Such injuries are rarely to be expected in high-energy trauma. Degenerative damage or iatrogenic injuries in the context of hip surgery are more frequently identified as the cause. Clinically, in addition to lateral hip pain, limping is an important finding and depends on the extent of the tendon damage. In addition to the medical history and clinical examination, imaging by means of sonography and, above all, magnetic resonance imaging (MRI, possibly with artifact-reduced sequences in the presence of an endoprosthesis) are diagnostically groundbreaking. Therapeutically, a stepwise approach is indicated according to the extent of rupture and quality of the gluteal tendon and muscle tissues. Specific conservative training regimens, mini-open/endoscopic anatomic reconstruction techniques in cases of gluteal muscle integrity and muscle transfer techniques as salvage option with chronic mass ruptures are available. The common goal is the restoration of everyday occupational and private activities to regain the quality of life.

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Authors and Affiliations

  1. ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland

    P. Weber, N. Harrasser & H. Gollwitzer

  2. Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    N. Harrasser, V. Twardy &  I. J. Banke

  3. MVZ ATOS, Effnerstr. 38, 81925, München, Deutschland

    N. Harrasser

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  5. I. J. Banke
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Correspondence to I. J. Banke.

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Interessenkonflikt

H. Gollwitzer: Finanzielle Interessen: Forschungsförderung zur Durchführung einer klinischen Studie: Medacta. Honorar und Reisekosten für Operationskurse, Honorar für Vorträge, Honorar für Hospitationen: Medacta. Honorar für Operationskurse: Arthrex. Honorar für Vortragstätigkeit: Plasmaconcept. Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: Medacta. I.J. Banke: Finanzielle Interessen: Unterstützung von Forschungsprojekten zur biomechanischen Hip-Bridge-Testung: Arthrolab München, Arthrex (Anker‑/Nahtmaterial, humane Präparate, biomechanische Testung). Instruktorentätigkeit: Arthrex (internationale Operationskurse und Workshops). Beratertätigkeit: Arthrex (Produktanwendungs-Techniken). P. Weber, N. Harrasser und V. Twardy geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Weber, P., Harrasser, N., Twardy, V. et al. Avulsionsverletzungen des M. glutaeus medius und M. glutaeus minimus. Unfallchirurg 124, 526–535 (2021). https://doi.org/10.1007/s00113-021-01034-2

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