关节镜下不同入路对臀筋膜挛缩症手术疗效观察

The surgical treatment effects via arthroscopic“contralateral”or“ipsilateral”approaches in treatment of gluteal fascial contracture

目的对比分析关节镜下“对侧”与“同侧”入路治疗臀筋膜挛缩症的手术疗效,并评估术后臀肌容积。方法回顾性纳入2015年1月至2018年6月行手术治疗的臀肌筋膜挛缩症患40例,其中13例行“对侧”入路下关节镜松解术,27例接受“同侧”入路下的关节镜松解手术,平均随访周期(29.4±17.6)个月。评价所有患者臀肌容积情况,并纳入手术时间、术中出血量、切口长度发症发生情况、VAS评分治疗满意度等。结果所有患者平均手术时间、出血量、切口长度满意度及并发症感染率为(26.3±4.1)min、(3.8±1.5)ml、(3.6±0.4)cm、97.5%、10%;股骨头水平截面和小转子水平截面臀部肌肉面积较术前增加(P>0.05),大转子水平截面和转子间水平截面臀部肌肉面积较术前减少(P<0.05);不同入路患者间上述指标各不相同,但差异无统计学意义(P>0.05)。结论关节镜下“对侧”及“同侧”入路臀肌肌膜挛缩症松解术均可获得良好的临床效果,经治疗患侧臀部肌肉的容积有所增加。

Objective To investigate the surgical treatment effects via arthroscopic“contralateral”or“ipsilateral”approaches in treatment of gluteal fascial contracture.Methods Forty patients with gluteal muscle contracture who underwent surgical treatment from January 2015 to June 2019 were enrolled in thestudy,of whom,13 cases underwent arthroscopic release via“contralateral”approach,and 27 cases underwent arthroscopic release via“ipsilateral”approach,with the average follow-up time being(29.4±17.6)months.The gluteal muscle volume,and the operation time,intraoperative blood loss,incidence of incision length,and VAS score as well as treatment satisfaction were statistically analyzed.Results The average operation time,blood loss,incision length,satisfaction and complication rate in all the patients were(26.3±4.1)min,(3.8±1.5)ml,(3.6±0.4)cm,97.5%,10%,respectively.After operation the muscle areas of horizontal section of femoral head and horizontal section of lesser trochanter buttocks were significantly increased(P>0.05),however,the hip muscle areas of the horizontal section of the greater trochanter and the horizontal section between the trochanters were significantly decreased(P<0.05).Moreover the above indexes were different between the two approaches,but the differences were not statistically significant(P>0.05).Conclusion Arthroscopic“contralateral”and“ipsilateral”approaches can obtain satisfactory effects on gluteal muscle contracture,both of themethods can increase the volume of the affected side buttock muscle.