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Belyak EA, Lazko FL, Sufianov AA, Paskhin DL, Prizov AP, Lazko MF, Sagdiev RK, Zagorodnij NV. Endoscopic Treatment of Deep Gluteal Syndrome: 3-Portal Technique. Arthrosc Tech 2024; 13:103052. [PMID: 39308567 PMCID: PMC11411350 DOI: 10.1016/j.eats.2024.103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/10/2024] [Indexed: 09/25/2024] Open
Abstract
We describe all-endoscopic deep gluteal syndrome treatment and sciatic nerve decompression at the infrapiriformis space. Surgery is performed with the patient in the prone position with the usual arthroscopic instruments and pump. The first step includes performing placement of 2 initial portals (medial and median) without fluoroscopy in the area of the ischial tuberosity and conjoint tendon, as well as release in this area with a subsequent shift in the lateral direction. The second step includes performing placement of an additional lateral portal for instruments, switching the camera into the median portal, and visualizing the sciatic nerve and its decompression at the infrapiriformis space and upper part of the thigh area. The postoperative period includes early activation, immediate passive and active motion after surgery, and full weight bearing the day after surgery.
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Affiliation(s)
- Evgeniy Aleksandrovich Belyak
- Moscow State City Hospital in Honor of Buyanov V.M., Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Fjodor Leonidovich Lazko
- Moscow State City Hospital in Honor of Buyanov V.M., Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Albert Akramovich Sufianov
- Russian Academy of Sciences, Russia
- Department of Neurosurgery, I.M. Sechenov First State Medical University (Sechenov University), Moscow, Russia
- Educational and Scientific Institute of Neurosurgery, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- Federal Center of Neurosurgery, Tyumen, Russia
| | | | - Aleksej Petrovich Prizov
- Moscow State City Hospital in Honor of Buyanov V.M., Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Maksim Fjodorovich Lazko
- Moscow State City Hospital in Honor of Buyanov V.M., Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Ranel Khamitovich Sagdiev
- Department of Neurosurgery, I.M. Sechenov First State Medical University (Sechenov University), Moscow, Russia
- Federal Center of Neurosurgery, Tyumen, Russia
| | - Nikolaj Vasil’evich Zagorodnij
- Russian Academy of Sciences, Russia
- Orthopedic Department, National Medical Research Center for Traumatology and Orthopedics Named After N.N. Priorov of the Ministry of Health of the Russian Federation (Federal State Budgetary Institution)
- Orthopedic Department, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
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Hatem M, Canavan KE, Martin RL, Dawkins J, Martin HD. Usefulness of magnetic resonance imaging to diagnose greater trochanteric-ischial impingement. Proc (Bayl Univ Med Cent) 2021; 34:460-463. [PMID: 34219926 DOI: 10.1080/08998280.2021.1897352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Extra-articular impingement between the femur and ischium is increasingly recognized as a cause of hip pain. The purpose of this study was to assess the diagnostic parameters for greater trochanteric-ischial impingement (GTI) in magnetic resonance imaging (MRI) studies. Seven patients (seven hips) diagnosed with GTI were retrospectively identified. For each of these seven patients, three controls were matched by gender, height, and weight to create a control group of 21 asymptomatic hips. The same technique and positioning were utilized to acquire the MRIs in the GTI and control groups. The MRI was performed with the lower limbs in a functional position reproducing the midstance phase of the gait cycle. The greater trochanteric-ischial distance was measured in the axial cut showing the shortest distance between the greater trochanter and the ischial tuberosity. The mean greater trochanteric-ischial distance was 26.2 mm in the GTI group and 33.8 mm in the control group (P < 0.01). Greater trochanteric-ischial distance ≤28 mm had a sensitivity of 86% and specificity of 86% in identifying GTI. In conclusion, utilizing MRI with functional positioning of the lower limbs, greater trochanter-ischial distance ≤28 mm is helpful to diagnose GTI in women.
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Affiliation(s)
- Munif Hatem
- Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, Texas
| | | | - RobRoy L Martin
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania
| | - Jonathan Dawkins
- Department of Orthopedic Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Hal David Martin
- Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, Texas
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