臀肌松解、臀大肌止点肌腱“Z”字延长术治疗复发性臀肌挛缩症

The Treatment of Gluteal Tendon Release plus Z-shape Elongation of Gluteus Maximus Ending Point for Recurrent Gluteal Muscle Contracture

目的分析臀肌筋膜挛缩症术后复发的原因，探讨再次行臀肌筋膜松解术并臀大肌止点肌腱“Z”字延长术的临床效果。方法2007年1月～2012年12月共收治臀肌筋膜挛缩症术后复发患者15例（24侧），分析其术后复发原因，均采用臀肌筋膜松解＋臀大肌止点肌腱“Z”字延长术再次手术治疗。结果本组病例术后复发的原因：3例（6侧）诊断及分型错误，9（14侧）例手术方式的选择不当，3例（4侧）术后未进行功能锻炼。本组患者均获随访，平均时间1．8年（8月-3年）。术后疗效评价：优13例（21侧），良2例（3侧），优良率达100％，效果满意。结论臀肌筋膜挛缩症术后复发原因诸多，术者应掌握臀肌筋膜挛缩症的诊断、分型，熟悉解剖；选择恰当的手术方式，术中彻底松解，可获得满意的活动度，必要时进行臀大肌止点肌腱“z”字延长术是手术成功的关键。

Objective To analyze the recurrence causes of gluteal muscle contracture and to explore the effect of gluteal tendon release and Z-shape elongation of gluteus maximus ending point. Method 15 patients （24 hips） with gluteal muscle eontracture recurrence admitted from January 2007 to December 2012 were performed gluteal tendon release and Z-shape elongation of gluteus maximus ending point. Results The recurrence causes were mis-diagnosis and classification in 3 cases （6 hips）, inappropriate surgical procedures in 9 cases （ 14 hips） and non-functional exercise in 3 cases （4 hips）. All cases were followed up for 8 months to 3 years with an average of 1.8 years. The outcomes showed excellence in 13 cases （21 sides） , good in 2 cases （3 sides）, and the fineness rate was 100%. Conclusions The recurrence of gluteal muscle contracture has many causes. The satisfied effect can be achieved by appropriate diagnosis and classification, familiar anatomy, suitable surgical approach and complete release. The Z-shape elongation of gluteus maximus tendon ending point is the key to successful operation.