小切口潜行松解三步康复训练法治疗臀肌挛缩症的临床研究

Treatment of gluteus muscles contracture with small incision insidious lysis and three steps rehabilitative drills

[目的]探讨小切口潜行松解三步康复训练法治疗臀肌挛缩症的临床疗效。[方法]自1988年2月～2006年2月,应用小切口潜行松解三步康复训练法治疗臀肌挛缩症118例(治疗组)、臀大肌松解术治疗56例(对照组)。对臀肌挛缩症的临床分型、自行设计的两种特异性高物理诊断方法侧卧位屈肢交腿试验和侧卧位伸肢交腿试验设计机理、小切口潜行松解手术的操作要点、三步康复训练法的具体实施进行探讨。[结果]随访1～8年,参照黄耀添疗效评定标准,术后1.5个月进行早期临床疗效评定,治疗组手术优良率明显大于对照组,数据经x2检查,有显著性差异。术后6个月临床疗效评定,手术优良率治疗组为95.7%;对照组为91.3%。[结论]小切口潜行松解治疗臀肌挛缩症定位准确、操作简便、出血少、不易损伤坐骨神经。三步康复训练法符合生理特点,易为患儿接受,髋关节功能恢复快,多在1～1.5个月恢复正常。特别是应用作者设计的侧卧位屈肢交腿试验和侧卧位伸肢交腿试验,做到了术前诊断有据,术中松解有度,术后训练有法。

[Objective] To investigate the clinical effects in the treatment of gluteus muscles contracture of small incision insidious lysis and three steps rehabilitative drills. [ Method] One hundred and eighteen patients were treated with small incision insidious lysis and three steps rehabilitative drills （ treatment group）, and fifty - six patents with gluteus maximus lysis （control group） from February 1988 to February 2006. Clinical classification of gluteal muscle contracture, mechanism of crook -lateral and spread- lateral limb cross -leg tests designed by the author, main points of small incision insidious lysis and implement of three steps rehabilitative drills were evaluated. [ Result] The cases were followed up for 1-8 years, clinical out-comes were evaluated by the Huang Yao - tian＇s scoring system. The early clinical effect were evaluated after 45 days of operation. All the results showed statistically significant difference （P 〈 0. 01 ） . [ Conclusion] Small incision insidious lysis has ad- vantages of accurate positioning , simple operation and minor damage. Three steps rehabilitative drills can meet the physiological characteristics and be easily accepted. Function of hip joint can recover quickly. Crook - lateral limb cross - leg test and spread - lateral limb cross -leg test have a great practical value for preoperative diagnosis, operating lysis and postoperative drills.