不对称性臀肌挛缩致骨盆倾斜及双下肢不等长:135例治疗分析

Pelvic oblique and inequality of lower extremities induced by unsymmetrical gluteal muscle contracture:an analysis of 135 cases

目的:探讨不对称性臀肌挛缩所致骨盆倾斜及双下肢不等长的病机、病理、临床表现及干预。方法:对1992-06/1999-06南方医科大学附属南方医院收治的135例不对称性臀肌挛缩所致骨盆倾斜及双下肢不等长患者进行体检及手术治疗。结果:患者年龄6～24岁,查体除有臀肌挛缩本身的体征外,尚有双下肢不等长、骨盆倾斜及脊柱腰段代偿性侧凸畸形,双侧下肢长度差距为0.5～6.2cm,平均1.7cm。而实际测量双侧大转子到内踝或髂前上棘到内踝的长度双侧相等。所有患者均行臀肌挛缩松解术,至术后2～4周,患者的外观畸形均基本消失,随访1年6个月～8年(平均4年8个月)畸形无复发。结论:不对称性臀肌挛缩的挛缩带牵拉可造成骨盆倾斜、脊柱侧凸及双下肢不等长,挛缩不对称程度越高,畸形越严重。手术完全松解挛缩组织可解除畸形。臀肌挛缩所产生的畸形均为代偿性,治疗时不可矫正各畸形而忽略了臀肌挛缩的治疗。

AIM:To investigate the mechanism,pathology and clinical manifestation of pelvic oblique and inequality of lower extremities induced by unsymmetrical gluteal muscle contracture. METHODS:From June 1992 to June 1999,physical examination and surgical treatment were applied to 135 patients with pelvic oblique and inequality of lower extremities induced by gluteal muscles contracture in Nanfang Hospital,Southern Medical University. RESULTS:The patients,aged from 6 to 24 years,besides physically having the manifestation of gluteal muscle contracture,had pelvic oblique,compensatory scoliosis of lumber spine,and inequality of lower extremities ranged from 0.5 to 6.2 cm with the average of 1.7 cm.But acutely the bilateral lengths from both great trochanter and superior iliac spine to the ankle were the same for all the patients.All the patients underwent release of the contracted tissues,and the external deformity of patients could disappear from 2 to 4 weeks postopratively.After follow-up for 1.5 to 8 years(average 4 years and 8 months),there was no deformity reoccurring in the patients. CONCLUSION:The manifestation of pelvic oblique,scoliosis and inequality of lower extremities can be induced by the traction of contracture band in patients with unsymmetrical gluteal muscle contracture.The more unsymmetrical is the contracture,the more serious will be the deformity.Complete release of the contracture tissue can correct the deformity.The deformity manifestation in gluteal muscle contracture patients was compensatory,and it is forbidden to correct the deformity without the treatment of muscle contracture.