臀肌筋膜挛缩症合并双下肢假性不等长

The contracture of gluteal muscles and fascia associated with pseudodiscrepancy of both lower limbs

目的:探讨臀肌筋膜挛缩症合并双下肢假性不等长的发病机理及治疗方法。方法:自1980年3月～2003年10月共收治并发双下肢假性不等长的臀肌筋膜挛缩症73例,男42例,女31例;年龄4～22岁,平均12岁。肢体外观相对不等长小于2cm的39例,2～4cm的31例,大于4cm的3例。手术切断松解臀筋膜、臀大肌及阔筋膜张肌的挛缩带,并对挛缩的臀中(小)肌行“Z”形切断延长,术后并腿屈髋卧床3d,然后下地作功能锻炼。结果:平均随访39个月,70例于术后15～45d双下肢假性不等长得以完全纠正,以后无复发;3例大龄患者遗留1cm差别的外观不等长。结论:臀中(小)肌单侧或两侧挛缩程度不等导致骨盆倾斜是造成双下肢假性不等长的原因。“Z”形切断延长挛缩的臀中(小)肌及术后合理与积极的功能锻炼可治愈此症。

Objective:To explore the pathogenesy and therapeutic methods of gluteal muscles and fascia contracture associated with both lower limbs pseudodiscrepancy.Method:From March 1980 to October 2003,73 patients of gluteal muscles and fasica contracture associated with both lower limbs pseudodiscrepancy were analyzed retrospectively.There were 42 males and 31 females,with the average age 12 years old(4~22 years).Unequal leg lenglth was less than 2 cm in 39 cases,between 2 cm to 4 cm in 31 cases,more than 4 cm in 3 cases.The contracture band of gluteus maximus muscles was cut off and released.So did the contracture band of gluteal fascia and tensor fascia lata.A “Z”-shaped lengthening was performed when there was the contracture of gluteus medius muscles and gluteus minimus muscles.The patients had to lie on the bed with flexing of hip joint for 3 days,and then did functional exercises on the ground.Result:All cases were followed up for an average of 39 months.In 70 cases,pseudodiscrepancy was completely corrected in 15~45 days postoperatively,and there was no recurrence.The other 3 cases,who were elder ages,remained 1 cm pseudodiscrepancy in appearance.Conclusion:Pelvic obliquity caused by different seversity of contracture of gluteus medius(minimus)muscles leads to unequal leg length in both side or in one side.The desease can be cured through a “Z”-shaped lengthening operation to gluteus medius(minimus)muscles and suitable functional exercises.