臀大肌止点肌腱Z字延长术治疗重度臀肌挛缩症

Insertion of gluteus maximus tendo chilles lengthening with Z shaped for the treatment of severe gluteal muscle contracture

目的：探讨臀肌挛缩筋膜松解联合臀大肌止点肌腱Z字延长术治疗重度臀肌挛缩症的临床疗效。方法：选择2006年5月至2011年5月20例35侧重度臀肌挛缩症患者,其中男12例,女8例;年龄8~34岁,平均13岁;病程3~21年。患者均表现有不同程度的步态异常,双膝并拢不能下蹲,Ober征阳性,翘腿试验阳性,术中进行臀肌挛缩筋膜松解后,再将臀大肌止点肌腱作Z字延长治疗。随访对比观察治疗前后步态、并膝屈髋下蹲试验、交腿试验、髋关节内收及内旋活动度、髋关节外展后伸肌力（臀大肌力量）及运动能力等。结果：20例均获随访,时间1~5年。臀大肌松解均彻底,弹响均完全消失,Ober征均阴性,髋关节并膝屈髋、髋内收、髋内旋角度与术前比较差异有统计学意义（P〈0.01）,臀肌肌力得到保护,髋关节活动度及运动能力等恢复良好,其中优31侧,良4侧。结论：对于重度的臀肌挛缩患者,在进行传统的臀肌挛缩筋膜松解后再将臀大肌止点肌腱作Z字延长,无须过多切除正常的臀肌纤维及破坏关节囊,即可使臀肌挛缩得到最大程度的松解,术后疗效确切。

Objective：To investigate clinical curative effects of gluteal muscle contracture release combined with insertion of gluteus maximus tendo chilles lengthening with Z shaped in treating severe gluteal muscles contracture. Methods：From2006 May to 2011 May,20 patients（35 sides） with severe gluteal muscle contracture were collected,including 12 males and 8females,aged from 8 to 34 years old with an average of 13 years old;the courses of disease ranged from 3 to 21 years. All patients manifested abnormal gait at different degree,knees close together cannot squat,positive syndrome of Ober,positive test of alice leg. Gluteus contracture fascia release were performed firstly in operation,then insertion of tendo chilles lengthening with Z shaped were carried out. Preoperative and postoperative gait,and knee flexion hip extensor squat test,cross leg test,adduction and internal rotary activity of hip joint,stretch strength and motor ability after hip abduction were observed and compared. Results：Twenty patients were followed up for 1 to 5 years. Gluteus maximus were released thoroughly,and snapping hip was disappeared,Ober syndrome were negative. There was significant differences in knee flexion hip extensor squat test,adduction and internal rotary activity of hip joint,stretch before and after operation（P0.01）. Gluteus muscle strength was protected,stretch strength and motor ability of hip joint were recovered well. Among them,31 cases got excellent results and 4good. Conclusion：For severe gluteal muscles contracture,insertion of gluteus maximus tendo chilles lengthening with Z shaped performed after gluteus contracture fascia release could release gluteal muscle contracture to the greatest extent and obtain postoperative curative effect without resection of normal hip muscle fibers and destroy joint capsule.