摘要
目的探讨单侧臀肌挛缩症的发病机制、诊断和治疗方法。方法 1990年1月-2009年9月,收治41例单侧臀肌挛缩症患者。男24例,女17例;年龄6～29岁,平均12岁。39例有明确反复臀肌注射史。左侧9例,右侧32例。主要临床症状为步态异常、跛行。检查示骨盆倾斜,下肢相对不等长,脐至内踝距离相差1.2～3.8 cm,平均2.1 cm。骨盆X线片示股骨大粗隆突出,骨盆向患侧倾斜。CT检查示除骨盆倾斜外骨结构无异常,患侧臀肌变薄、萎缩。采用经大转子后外侧纵弧形切口行臀肌挛缩松解术,术后行双下肢皮肤牵引及康复训练。结果术后切口均Ⅰ期愈合。41例均获随访,随访时间1～20年,平均随访5年。患者臀肌挛缩体征消失。术后1年34例双下肢等长,5例遗留轻度骨盆倾斜,2例骨盆倾斜较明显;根据刘国辉等疗效评定标准,获优33例,良6例,差2例,优良率95.12%。结论单侧臀肌挛缩症致骨盆倾斜出现双下肢相对不等长,采用大转子后外侧纵弧形切口行臀肌挛缩松解术配合双下肢皮肤牵引及康复训练可获满意疗效。
Objective To investigate the pathogenesis,diagnosis,and treatment of unilateral gluteal muscle contracture.Methods Between January 1990 and September 2009,41 patients with unilateral gluteal muscle contracture were treated and the clinical data were retrospectively analysed.Among them,24 were male and 17 were female with an age range from 6 to 29 years（mean,12 years）.Thirty-nine patients had a defi nite history of repeat intragluteal injection.The locations were the left side in 9 cases and the right side in 32 cases.The main clinical manifestations included lameness and abnormal gait.The medical examination showed pelvic oblique and relative inequality of lower limbs with a mean difference of 2.1 cm（range,1.2-3.8 cm） in the distance form navel to malleolus medials.The X-ray fi lms of pelvis showed outpouching trochanter of femur and pelvic oblique.The CT scans showed no abnormal finding except pelvic oblique and gluteal muscle contracture.The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed,followed by the skin traction of both legs and rehabilitation exercise.Results All incisions healed by first intention.Forty-one patients were followed up 1-20 years（mean,5 years）,and the signs of gluteal muscle contracture disappeared.After 1 year of operation,34 patients had equal leg length,5 patients had mild pelvic oblique,and 2 patients had obvious pelvic oblique.According to LIU Guohui et al.evaluation standard,the results were excellent in 33 cases,good in 6 cases,and poor in 2 cases with an excellent and good rate of 95.12% at 1 year after operation.Conclusion Unilateral gluteal muscle contracture leads to pelvic oblique and inequality of lower limbs,and it can be cured with the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter,combined with postoperative skin traction and rehabilitation exercises.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第5期530-532,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
单侧臀肌挛缩症
下肢相对不等长
臀肌挛缩松解术
Unilateral gluteal muscle contracture Relative inequality of lower limbs Release of the gluteal muscle contracture
