平卧位关节镜下由内向外髂胫束松解术治疗双侧臀肌挛缩症的疗效观察

Clinical efficacy of the treatment of bilateral gluteal muscle contracture by inside-out iliotibial band release under arthroscopy in the supine position

目的探究平卧位关节镜下由内向外髂胫束松解术对双侧臀肌挛缩症的临床治疗效果。方法前瞻性的非随机对照试验。纳入2021年4月至2022年8月因双侧臀肌挛缩症收入解放军总医院第四医学中心骨科医学部运动医学科、拟行手术治疗的46例患者。根据患者意愿依手术方案将患者分为两组:平卧组采用平卧位关节镜下由内向外髂胫束松解术,侧卧组采用侧卧位关节镜下由外向内髂胫束松解术。记录所有患者的非手术操作总时长和手术操作总时长。比较两组术前3 d内及手术至少2个月后臀肌挛缩症功能量化评分及并发症发生情况。结果平卧组共26例,男11例,女15例,年龄(31.8±7.3)岁;侧卧组共20例,男7例,女13例,年龄(30.6±6.3)岁。两组患者的性别、年龄、体质指数(BMI)、术后随访时间差异均无统计学意义(均P>0.05)。平卧组非手术操作总时间短于侧卧组[(47.9±10.4)min比(63.9±7.5)min,P<0.001]。平卧组的手术操作总时长与侧卧组差异无统计学意义[M(Q_(1),Q_(3)),31.0(27.0,43.5)min比33.0(24.8,38.0)min,P>0.05]。平卧组和侧卧组的术后臀肌挛缩功能量化评分较术前均有改善[分别为93.0(85.0,98.0)分比61.0(50.5,66.8)分,P<0.001和(88.5±6.9)分比(63.6±9.6)分,P<0.001]。平卧组与侧卧组之间,术前和术后2个月的臀肌挛缩功能量化评分差异均无显著统计学意义[分别为(59.3±11.9)分比(63.6±9.6)分,P>0.05和93.0(85.0,98.0)分比89.5(84.0,94.8)分,P>0.05]。两组术后各有2例患者出现皮下血肿,发生率差异无统计学意义(P>0.05),且均在术后2周内消退。两组患者术后均未出现术区脂肪液化、感染、髋关节外展肌力下降、下肢神经损伤等并发症。结论平卧位关节镜下由内向外髂胫束松解术治疗双侧臀肌挛缩症可有效提升临床工作效率,疗效确切,是一项值得推广的手术方案。

Objective To investigate the clinical efficacy of bilateral gluteal muscle contracture treated with inside-out iliotibial band release under arthroscopy in the supine position.Methods A prospective non-randomized controlled trial.Forty-six patients admitted to the Department of Sports Medicine,Senior Department of Orthopedics,the Fourth Medical Center of PLA General Hospital from April 2021 to August 2022 for bilateral gluteal muscle contracture and proposed surgical treatment were enrolled.The subjects were divided into two groups according to the preferred surgical protocols of the patients:the supine position group was treated with inside-out iliotibial band release under arthroscopy in the supine position,and the operation in lateral position group was carried out with outside-in iliotibial band release under arthroscopy in the lateral position.The total duration of non-surgical operations and the total duration of surgical operations were recorded for all patients.The gluteal muscle contracture disability scale within 3 days before surgery and at least 2 months after surgery were compared between the two groups,and the occurrence of complications between the two groups was compared too.Results There were 26 cases in the supine position group,11 males and 15 females with a mean age of(31.8±7.3)years;and there were 20 cases in the lateral position group,7 males and 13 females with a mean age of(30.6±6.3)years.The differences in gender,age,body mass index(BMI)and postoperative follow-up time between the two groups were not statistically significant(all P>0.05).The total duration of non-surgical operations was shorter in the supine position group than in the lateral position group[(47.9±10.4)min vs(63.9±7.5)min,P<0.001].There was no statistically significant difference in the total duration of surgical operations between the supine position group and the lateral position group[31.0(27.0,43.5)min vs 33.0(24.8,38.0)min,P>0.05].The postoperative gluteal muscle contracture disability scales were significantly improved in both the supine position and lateral position groups when compared with those before the operation[93.0(85.0,98.0)vs 61.0(50.5,66.8),P<0.001 and 88.5±6.9 vs 63.6±9.6,P<0.001,respectively].There was no statistically significant difference in the gluteal muscle contracture disability scale between the supine position and lateral position groups before and 2 months after surgery[59.3±11.9 vs 63.6±9.6 and 93.0(85.0,98.0)vs 89.5(84.0,94.8),both P>0.05,respectively].Two patients in each group developed subcutaneous hematoma after surgery,and all of them resolved within 2 weeks after surgery,the difference in complication incidence rate was not statistically significant(P>0.05).No postoperative complications such as fat liquefaction in the operated area,infection,decreased hip abductor muscle strength or nerve injury in the lower extremity were observed in both groups.Conclusion The treatment of bilateral gluteal muscle contracture by inside-out iliotibial band release under arthroscopy in the supine position can effectively improve clinical efficiency,with definite efficacy,and it is an operative program worth promoting.