重型臀肌挛缩症的诊断及手术治疗

Diagnosis and suegical treatment of severe gluteus maximus contracture

目的探讨重型臀肌挛缩症的诊断及手术治疗。方法自1993年9月～2001年10月共收治重型臀肌挛缩症患者89例,资料完整的82例。所有患者均符合以下条件:(1)侧身前移步态;(2)站立位驼背畸形,髋过伸,坐位或下蹲时双腿呈蛙式状;(3)臀部肌肉明显萎缩,肢体其它部位肌肉无异常,屈髋≥90°时,髋强迫外展≥45°;(4)X线检查显示脊椎及骨盆结构无异常,病史较长者可有代偿性脊柱后凸及股骨颈前倾角增大等改变。本组均行臀大肌止点上移术,其中臀中肌及臀小肌切断松解75例(91.46%);皮下组织切开、皮肤松解31例(37.80%),皮肤“Z”形延长46例(56.10%),“L”形切开皮瓣转位、皮肤缺损处游离植皮5例(6.10%)。结果平均随访28个月。全部患者术后功能改善满意;驼背与骨盆后倾消失80例(97.60%);步态基本恢复正常69例(84.15%),轻度摇摆步态12例(14.63%),仍明显跛行1例(1.22%)。与术前相比,屈髋功能平均改善93°,屈髋90°时内收功能平均改善76.1°。单侧外展肌力较差者7例(8.54%),双侧外展肌力较差者2例(2.44%)。术后1年与3年髋关节功能恢复程度无明显差异。结论重型臀肌挛缩症患者采用臀肌松解、臀大肌止点上移、皮肤延长或植皮术治疗,疗效满意。

Objective The present was to make the diagnosis in order to improve the effects of oper-ation for the patients with severe gluteus maximus contracture.Methods Of 1856cases,89patients were diagnosed as severe gluteus maximus contracture treated in our hospital between September1993and Octo-ber2001.The diagnostic criteria was depending on the following symptoms and signs:1)Anterolateral shift gait;2)Kyphosis of spine,over abduction of hip in standing,and frog legs while sitting and squatting;3)A-trophy of gluteus maximus while other muscles normal.When patients were on the hip flexion more than90°,they were forced on hip abduction more than45°;4)Normal pelvic and vertebral X-ray findings.Pa-tients who had longer history could have the compensation alteration of kyphosis and increase of anteversion angle of the neck of femur.All patients had undertaken operation of upwards shift of the insertion of gluteus maximus,74cases(91%)of them had undertaken severing and release of gluteus medius and minimus,34cases(38.2%)underwent subcutaneous tissue incision and skin releasing,50cases(56.2%)had undertaken'Z'skin elongation,5cases(5.6%)received'L'skin flap transposition or free skin grafting on cutaneous deficiency area.Results The wound healed at one stage in all patients.Eighty-two patients were followed up from12to36months(mean,28months).All patients were satisfactory with their postoperative improve-ments.Eighty(97.6%)patients were free from kyphosis and pelvic retroversion;69(84.15%)patients were almost recovered to normal gait;12(14.63%)patients remained mild swinging gait;1(1.22%)patient was still crippled.Comparing with preoperative condition,the hip flexion was improved with an average93°.when patients were on hip abduction90°,hip adduction was improved with an average76.1°,7(8.5%)patients had unilateral abduction weakness.2(2.5%)cases had bilateral abduction weakness.There is no significant difference between the recovery levels of the hip functions of the patients from1to3year follow up.Con-clusion Combined therapy of gluteus myotomy,release of gluteus medius and minimus with transfer of the insertion of glutens maximus upwards and skin elongation or skin grafting operations may gain satisfactory effects for patient with severe gluteus maximus contracture.