对平卧位关节镜下由内向外松解髂胫束治疗双侧臀肌挛缩症的疗效观察  

Inside-out release of iliotibial band with arthroscope in a supine position for bilateral gluteal muscle contracture

作　　者：吴毅东 于康康 安明扬 李中耀 王博达 李奕博 王龙[1] 王明新[1] 李春宝[1] Wu Yidong;Yu Kangkang;An Mingyang;Li Zhongyao;Wang Boda;Li Yibo;Wang Long;Wang Mingxin;Li Chunbao(Department of Sports MedicineSenior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing 100048, China)

机构地区：[1]解放军总医院第四医学中心骨科医学部运动医学科,北京100048

出　　处：《骨科临床与研究杂志》2022年第4期198-202,共5页Journal Of Clinical Orthopedics And Research

基　　金：国家自然科学基金面上项目(82072517);国家重点研发计划项目(2019YFE0126300)。

摘　　要：目的 探讨平卧位关节镜下由内向外松解髂胫束治疗双侧臀肌挛缩症的方法与疗效。方法 2021年4月至2022年2月,解放军总医院第四医学中心骨科医学部运动医学科采用平卧位关节镜下由内向外松解髂胫束方法治疗双侧臀肌挛缩症患者20例;男7例,女13例;年龄17~45(31.3±7.8)岁。术前所有患者双髋部均存在内收内旋活动障碍、弹响,Ober's征、划圈征、交腿试验中至少有1项以上为阳性。手术采用平卧体位,以大转子和髂胫束之间的自然解剖腔隙为手术操作空间,建立前外侧入路、远端前外侧辅助入路。自股骨大转子外壁中心,由大转子侧向皮下组织侧横向离断髂胫束。若查体体征未完全缓解,则进一步沿大转子后缘由远端向近端松解臀大肌止点处腱性组织,直至体征完全缓解。术中记录术前准备时长与手术时长;手术前后通过臀肌挛缩症功能量化评分表评估患者功能改善情况;术后记录手术并发症。结果 术前准备时长为(34.2±9.0)min;手术时长为(37.5±12.9)min;术后随访时间为(6.7±3.0)个月。术前臀肌挛缩症功能量化评分为(59.6±11.0)分,术后臀肌挛缩症功能量化评分(91.0±7.2)分(P<0.05)。2例术后出现短暂伤口血肿症状。所有患者未见髋关节外展肌力减弱、脂肪液化、神经损伤症状。结论 平卧位关节镜下由内向外松解髂胫束治疗双侧臀肌挛缩症短期预后良好,术后功能恢复好,无严重手术并发症,是一种有望推广的创新技术。Objective To explore the method and efficacy of inside-out release of iliotibial band with arthroscope in a supine position for bilateral gluteal muscle contracture.Methods From April 2021 to February 2022,20 patients with bilateral gluteal muscle contracture were treated by inside-out release of iliotibial band with arthroscope in a supine position in Department of Sports Medicine Senior Department of Orthopedics,the Fourth Medical Center of PLA General Hospital.The series included 7 males and 13 females with a and cross-leg test were positive.The range of patients'age was 17-45(31.3±7.8)years.All patients had adduction and internal rotation disorder and snapping in both hips before surgery,and at least one or more of Ober's sign,circle sign,were placed in a supine position on an operating table.The operation zone was separated between the greater trochanter and the iliotibial band.Two arthroscopic portals were used:anterolateral portal,distal anterolateral accessory portal.The iliotibial band was transected completely from the side of the greater trochanter to the side of the subcutaneous tissue over the center of greater trochanter.If the symptoms were not completely relieved,the gluteus maximus tendon was released from distal to proximal at the posterior aspect of greater trochanter until the symptoms were completely relieved.The duration of preoperative preparation and the duration of surgery were recorded intraoperatively.The gluteal muscle contracture disability scale(GDS)was evaluated before surgery and at the last follow-up,and postoperative complications were recorded.Result The mean preoperative preparation time was(34.2±9.0)min and the mean operative time was(37.5±12.9)min.The mean postoperative follow-up time was(6.7±3.0)months.The mean GDS was(59.6±11.0)preoperatively and(91.0±7.2)postoperatively(P<0.05).In the postoperative period,2 patients had transient wound hematoma.No signs of hip abductor weakness,fat liquefaction or nerve injury were found in all patients.Conclusion Inside-out release

关 键 词：关节镜探查 疗效分析 臀肌挛缩症 

分 类 号：R687.3[医药卫生—骨科学]