臀肌挛缩症皮下松解术相对安全区的确定及临床应用  

Determination and clinical application of relatively safe region for percutaneous lysis of gluteal muscle contracture

作　　者：胡军祖[1] 佟磊[1] 蒋常文[1] 肖荣驰[1] 孙超[1] 张帆[1] 王锐英[1] 

机构地区：[1]桂林医学院附属医院骨科,广西桂林541001

出　　处：《中国矫形外科杂志》2011年第5期386-388,共3页Orthopedic Journal of China

基　　金：桂林市科学研究与技术开发计划项目(编号:20100128-4)

摘　　要：[目的]通过解剖学研究探讨臀肌挛缩症手术操作的相对安全区,并在临床验证相对安全区皮下松解术治疗臀肌挛缩症的可行性。[方法]通过对51具尸体标本102侧臀部的解剖研究,确定臀部手术操作的相对安全区,并在临床应用。[结果]①臀肌挛缩症手术操作的相对安全区：臀上神经最下支的体表投影的弧线与大转子外侧最凸点形成一类扇形区域内重要血管神经分布,无论何种体位坐骨神经均无法到达该区域,为手术操作的相对安全区。②临床应用23例,经12～29个月随访,平均19.7个月,术后患者均恢复正常步态或明显改善,均无坐骨神经损伤等严重并发症。[结论]臀肌挛缩症手术操作的相对安全区为臀上神经最下支的体表投影与大转子外侧最凸点所构成的类扇形区域,在此区域内操作不易损伤坐骨神经、臀上神经等重要神经、血管,临床应用后,效果良好。[Objective]To determine the relativelay safe region of the operation for gluteal muscle contracture by anatomy and investigate the feasibility of the subcutaneous release operation of gluteal muscle contracture in relatively safe areas. [Methods]The relatively safe region was determined after 102 limbs of 51 cadavers were dissected,and was verification in operation.[Results]①The relatively safe region of operation： the similar scalloped area enclosed by the projective line of the lowest branch of superior gluteal nerve and the most lateral protrusive point of the greater trochanter was the relatively safe region.There were not important nerves and blood vessels in this region.The sciatic nerve was unable to move into the region in any position.②Twenty-three patients were followed for a mean of 19.7 months（range,12～29 months） after operation in the relatively safe region.All cases were significantly improved and returned to normal gait.No sciatic nerve injury and other severe complications occurred.[Conclusion]The similar scalloped area surrounded by the projective line of the lowest branch of superior gluteal nerve and the most lateral protrusive point of the greater trochanter is the relatively safe region.It will not damage the superior gluteus nerve,sciatic nerve and some more important nerves and blood vessels while operating in this region.Simplify operation gets good results in the region.

关 键 词：臀肌挛缩症 相对安全区 皮下松解术 

分 类 号：R687.3[医药卫生—骨科学]