关节镜下五步法臀肌松解治疗臀肌挛缩症

Arthroscopic five-step release of gluteus in the treatment of gluteal muscle contracture

目的探讨关节镜下五步法臀肌松解治疗臀肌挛缩症的临床疗效。方法回顾性分析2016年9月至2019年6月香港大学深圳医院收治的52例(104髋)臀肌挛缩症患者的临床资料。患者均采用关节镜下五步法臀肌松解术,其中轻型19例、中型25例、重型8例。根据患者术后髋关节活动范围和步态、并膝下蹲情况评定临床疗效,同时观察术后臀肌挛缩量化评分的变化。结果随访时间6~24个月,平均随访时间13.7个月。临床疗效优良率90%(优32例、良15例、可5例);术前及末次随访臀肌挛缩量化评分分别为(50.6±17.2)和(89.9±7.3)分,手术前后比较,差异有统计学意义(P<0.05)。术后早期摇摆步态2例、伤口积液1例,无感染及重要神经血管损伤并发症。结论关节镜下五步法臀肌松解是治疗臀肌挛缩症的有效方法,创伤小,并发症少,有利于早期康复锻炼,短期疗效满意。

Objective To explore the clinical effects of arthroscopic five-step release of gluteus for the treatment of gluteal muscle contracture(GMC).Methods A retrospective analysis of clinical data of 52 GMC patients(104 hips)treated by arthroscopic five-step gluteal muscle release in Hong Kong University-Shenzhen Hospital from September 2016 to June 2019 was conducted.Among the patients,there were mild contracture in 19,moderate in 25 and severe in 8.Clinical efficacy was evaluated according to postoperative hip functions,including the range of motion(ROM)of hip,gait patterns and double knee crouching,and the change of quantitative GMC score was observed after the surgery.Results The patients were followed up for 6 to 24 months,with an average follow-up time of 13.7 months.The excellent and good rate of clinical efficacy was 90%,with 32 cases of excellent,15 of good,and 5 of fair.Quantitative GMC score was(50.6±17.2)preoperatively and(89.9±7.3)at the latest follow-up,respectively.The difference between preoperation and postoperation showed statistically significant(P<0.05).At early period after the surgery,2 cases of swinging gait and 1 case of wound effusion had happened.No infections or important neurovascular injuries were found.Conclusion Arthroscopic five-step gluteal muscle relaxation is an effective method for the treatment of GMC,with less trauma and fewer complications,which is conducive to early rehabilitation exercise and satisfactory short-term efficacy.