关节镜下改良入路治疗成人中重度臀肌挛缩症的方法和疗效

Clinical effect and method of treating adult moderate and severe gluteal muscle contracture by arthroscopy with modified approach

目的探讨经关节镜下改良入路治疗成人中重度臀肌挛缩症(GMC)的方法和疗效。方法回顾性分析关节镜下治疗的288例GMC患者,其中属于Ⅱ度(中度)患者101例,Ⅲ度(重度)患者19例。行改良的股骨大转子前后方入路,在关节镜监视下显露挛缩带,采用等离子刀予以松解,术后早期进行积极的功能锻炼。采用GMC功能量化评分比较手术前后疗效,调查患者主观满意度。结果该组共120例(240髋)成人中重度GMC患者,单侧关节镜下松解手术时间10~30 min,平均18 min。术中单侧出血约2~10 mL,术后单侧引流量平均40 mL。2例切口皮下血肿并瘀斑,2例局部皮下积液,均经过保守治疗痊愈,无神经血管损伤、伤口感染、髋外展肌力减弱等并发症。术后随访2~72个月,平均36个月。在获得随访的102例患者中,所有患者髋关节内收内旋活动度均较术前明显改善,100例(98.0%)能并膝下蹲,98例(96.1%)能翘二郎腿,末次随访时患者GMC功能量化评分均较术前明显提高,由术前的(55.0±10.0)分提高到术后的(90.0±5.0)分,差异有统计学意义(P<0.05)。手术疗效非常满意97人,满意5人。结论经关节镜下改良入路治疗成人中重度GMC,具有创伤小、出血少、并发症少、手术及住院时间短和伤口美观等优点,结合术后早期功能锻炼和康复,疗效优良。

Objective To explore the effect and method of treating adult moderate and severe gluteal muscle contracture by arthroscopy with modified approach. Methods 288 cases of gluteal muscle contracture treated by arthroscopy were analyzed retrospectively, including 101 cases of degree Ⅱ(moderate) and 19 cases of degree Ⅲ(severe). The contracture band was exposed under arthroscopic monitoring and released by plasma knife. Functional exercise was performed early after operation. Then compare the curative effect before and after operation with the quantitative score of gluteal muscle contracture and investigate the patients’ subjective satisfaction. Results 120 cases(240 hips) of adult patients with moderate or severe bilatral gluteal muscle contracture were treated with arthroscopy. The unilateral operation time range from 10 to 30 minutes, with an average of 18 minutes. During the operation, there was about 2~10 mL blood flow from unilateral wound, and the average flow volume was 40 mL after the operation. There were 2 cases complicated with incision hematoma and ecchymosis, 2 cases of local subcutaneous effusion, all of which were cured by conservative treatment, without the complications of neurovascular injury, wound infection, reduction of abductor strength of hip. The average follow-up time was 36 months. In the 102 patients who were followed up, the adduction and rotation of hip joint in all patients were significantly improved compared with that before operation, 100 patients(98.0%) could squat with their knees closed, 98 patients(96.1%) could cross their legs. The quantitative score of gluteal muscle contracture function in the last follow-up was significantly higher than that before operation, from(55.0 ± 10.0) points before operation to(90.0 ± 5.0) points after operation, with a significant difference(P < 0.05). 97 patients were very satisfied with the effect of the operation and 5 patients were satisfied. Conclusion The treatment of adult moderate and severe gluteal muscle contracture by arthroscopy with modified approach has the advantages of less trauma, less bleeding, less complications, shorter operation and hospitalization time, and beautiful wound. Combined with early functional exercise and rehabilitation after operation, the treatment effect is excellent.