臀肌挛缩症二次手术原因分析及治疗对策  

Causes and Treatment of Gluteal Contracture Secondary Operation

作　　者：冯宗权[1] 赵新建[1] 张建平[1] 谭健韶[1] 蔡春水[1] 

机构地区：[1]广东省佛山市第一人民医院骨科,528000

出　　处：《中国矫形外科杂志》2003年第18期J001-J002,共2页Orthopedic Journal of China

基　　金：广东省医学科研项目No.B1998159

摘　　要：目的:探讨臀肌挛缩症二次手术原因及治疗对策。方法:2000年1月～2003年3月本科共收治臀肌挛缩症二次手术25例;分4种类型,Ⅰ型:15例,表现为臀肌挛缩症术后下肢不等长,走路跛行。Ⅱ型:4例,表现为术后髋关节活动受限,以髋关节屈曲内收受限为主。Ⅲ型:4例,表现为术后髋关节活动部分受限,骨盆平片显示有骨化性肌炎。Ⅳ型:2例,一侧臀部外展肌力减弱。全部接受手术,松解残余挛缩组织、切除骨化性肌炎、转移肌瓣修复肌力、填充创面。结果:随访23例,随访时间6～28个月,平均11个月,优良19例,部分改善2例,2例疗效差。结论:臀肌挛缩症初次手术松解不彻底或松解过度,将导致下肢活动部分受限或臀外展肌力减弱;止血不彻底 留皮下空洞,治愈后臀部继续肌注药物,将易导致臀肌骨化性肌炎,手术针对不同原因采用相对手术,重点松解挛缩组织、恢复肌力、修复创面。Objective: To analyze the causes and treatment measure of gluteal contracture secondary operation. Methods: From Jan. 2000 to Mar. 2003, there were 25 cases with gluteal contracture patients proceeded secondary operation. The patients were classified into 4 types : type Ⅰ15 cases with unequal limb length after first operation, type Ⅱ 4 cases with reduced hip activity in flection and adduction direction, type Ⅲ4 cases with reduced hip activity because of muscle ossification, type Ⅳ 2 cases with reduced strength in hip abduction. All of them received secondary operation in spite of how the former operation did. Released the remained contracture tissue in type Ⅰ.Ⅱ t or cut off the muscle in ossification condition in typeⅢ , and used muscle transplantation to regain the strength.to cover the section. Results:Twenty-three patients were follow-up for 6-28 months with an average of 11 months,good result in 19 cases, 2 casse just portion improve, and 2 cases with no improve. Conclusion: If the first operation for gluteal contracture patient releases too much contracture tissue will induce decrease in abduction strength; if not enough, limited lower limbs activity occur. Many reasons may cause gluteal -muscle ossification, like not enough hemostasis.a cavity just cover with skin.muscular injection at the glutea after operation et al. Any secondary operation should be based on different problems after the first one. The key points are to release the remained contracture tissue . recover the strength. and repair the section.

关 键 词：臀肌挛缩 二次手术 髋 松解 

分 类 号：R687[医药卫生—骨科学]