单侧臀肌挛缩症的诊断与治疗

Chinese Journal of Reparative and Reconstructive Surgery, May 2011, V ol. 25, No.5·530·

单侧臀肌挛缩症的诊断与治疗

陈小亮唐学阳蒋欣王道喜彭明惺刘利君

【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。

【关键词】单侧臀肌挛缩症下肢相对不等长臀肌挛缩松解术

DIAGNOSIS AND TREATMENT OF UNILATERAL GLUTEAL MUSCLE CONTRACTURE/CHEN Xiaoliang, TANG Xueyang, JIANG Xin, WANG Daoxi, PENG Mingxing, LIU Lijun. Department of Pediatrics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China. Corresponding author: LIU Lijun, E-mail: LL1964@ 【Abstract】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 fi nding 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 fi rst 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.

【Key words】Unilateral gluteal muscle contracture Relative inequality of lower limbs Release of the gluteal muscle contracture

臀肌挛缩症是由多种原因引起臀肌及其筋膜纤维化，导致髋关节外展外旋畸形和屈曲障碍的一种疾病[1]。主要临床症状为步态异常及髋关节屈曲、内收、内旋异常，治疗以消除上述症状为主要目的。临床一

作者单位：四川大学华西医院小儿外科（成都，610041）

通讯作者：刘利君，教授，硕士生导师，研究方向：小儿矫形外科，E-mail: LL1964@

网络出版时间：2011-4-2 16:56:56；网络出版地址：ki. net/kcms/detail/51.1372.R.20110402.1656.201105.49_013.html 旦确诊，手术是最有效的治疗方法。近年来，关于双侧臀肌挛缩症的报道较多，但对于单侧臀肌挛缩症并发骨盆倾斜报道较少；此病易引发双下肢相对不等长，但常被误诊为双下肢真性不等长甚至脊柱侧弯。现回顾分析1990年1月－2009年9月我科收治并获完整随访的41例单侧臀肌挛缩症患者临床资料，探讨其发病机制、诊断和治疗方法，为临床诊治提供依据。报告如下。