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大转子疼痛综合征(旧称大转子滑囊炎)

Author
Juan J Canoso, MD, MACR
Section Editor
Zacharia Isaac, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH
Translators
黄涛, 主任医师，教授

引言

大转子疼痛综合征(greater trochanteric pain syndrome, GTPS)是最常引起成人髋关节外侧疼痛的原因之一，在大多数情况下，GTPS都是由臀中肌或臀小肌的肌腱病变引起，伴不同程度的局部滑囊受累。

人们曾用“大转子滑囊炎”来描述髋关节外侧周围的所有疼痛。然而，先进的影像学和组织病理学研究表明，髋关节外侧疼痛患者不常见转子囊受累，该病况存在时也属于继发或伴发性表现。因此，用大转子滑囊炎来指代髋关节外侧疼痛的所有病因实属用词不当。事实上，原发性大转子滑囊炎很罕见，通常是由微生物引起。

本文将总结GTPS的临床表现、诊断、鉴别诊断和治疗。滑囊炎的概述和髋部及腹股沟的肌肉骨骼检查见其他专题。 (参见“滑囊炎：临床表现、诊断和治疗的概述”和“Musculoskeletal examination of the hip and groin”)

流行病学

GTPS很常见。目前最可靠的患病率估计值来自一项大型社区研究，其纳入了3000余例50-70岁成人，其中有15%的女性和6.6%的男性存在单侧GTPS[1]，8.5%的女性和1.9%的男性存在双侧GTPS。起病年龄通常超过50岁，男女比例约为1:4。

危险因素

GTPS的危险因素包括女性、肥胖、膝关节疼痛、髂胫束压痛和腰痛[2]。与GTPS相关的其他病况包括脊柱侧凸，下肢不等长，髋、膝和足关节疾病，以及足底筋膜炎、跟腱病变、拇外翻、Morton神经瘤或胼胝等足部疼痛性疾病。

                   

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-21.
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