A Retrospective Analysis of the Gluteal Muscles Contracture and Discussion of the Relative Problems

Summary: The operation methods, clinical classification, postoperative function exercise of gluteal muscles contracture were investigated. Clinically and retrospectively, treatment of 1280 patients with gluteal muscles contracture, being subjected to a 'Z-shaped' release lengthening operation and efficiency exercise, was clearly standardized. All the cases were followed up from 3 months to 2 years with the effective rate being 100 %, the cure rate being 98. 5 %, the recent complications being 5%, and the far complications being 0. 2 %. It was concluded that the clear diagnosis combined with standarized operation and efficiency functional exercise could greatly improve the therapeutic effects of gluteal muscles contracture.

Treatment of Severe Gluteal Muscle Contracture in Children

To investigate the efficacy of a combination therapy on gluteal muscle contracture, 286 definitely diagnosed patients were subjected to surgical treatment, and then functional exercises and physical therapy. The patients with severe symptoms were asked to have a set of specially-designed functional exercises. All the patients were followed up for 3 to 24 months by hospital visit, correspondence or telephone interview. The effective rate was 100%, and the curative rate was up to 94.6%. Few patients developed complications and relapse was rare. It is concluded that the combination therapy, including surgical removal of diseased tissues, functional exercises and physical therapy, is an effective approach for the treatment of severe juvenile gluteal muscle contracture.

Variations in the Course of the Inferior Gluteal Nerve and Artery: A Case Report and Literature Review

Variations in the course of the inferior gluteal nerve and artery were observed in Japanese cases (4/94 sides). In these variation cases, the inferior gluteal nerve exited the pelvis from the upper edge of the piriformis (suprapiriformis foramen) in 4/4 sides (4.26%). In 2/4 sides (2.13%), the normal inferior gluteal artery was not observed, except that a fine artery exited the pelvis from the inferior piriformis foramen to form an “arch” with the superior gluteal artery under the gluteal maximus in 1/4 side. Moreover, in 1/4 side, a twig of the internal pudendal artery exited pelvis from inferior piriformis foramen and distributed to the surrounding tissues. The present observations of the inferior gluteal nerve and artery course are very important and useful for surgeons and nurses.

Methicillin-resistant Staphylococcus aureus infected gluteal compartment syndrome with rhabdomyolysis in a bodybuilder

Gluteal compartment syndrome(GCS) is a rare condition. We present a case of gluteal muscle strain with hematoma formation, methicillin-resistant Staphylococcus aureus(MRSA) superinfection, leading to acute GCS, rhabdomyolysis and acute kidney injury. This combination of diagnoses has not been reported in the literature. A 36-year-old Caucasian male presented with buttock pain, swelling and fever after lifting weights. Gluteal compartment pressure was markedly elevated compared with the contralateral side. Investigations revealed elevated white blood cell, erythrocyte sedimentation rate, C-reactive protein, creatine kinase, creatinine and lactic acid. Urinalysis was consistent with myoglobinuria. Magnetic resonance imaging showed increased T2 signal in the gluteus maximus and a central hematoma. Cultures taken from the emergency debridement and fasciotomy revealed MRSA. He had repeat, debridement 2 d later, and delayed primary closure 3 d after. GCS is rare and must be suspected when patients present with pain and swelling after an inciting event. They are easily diagnosed with compartment pressure monitoring. The treatment of gluteal abscess and compartment syndrome is the same and involves rapid surgical debridement.

Bilateral Gluteal Reconstruction with Double Flap Secondary to Biopolymers Injection

The injection of adjuvant substances for aesthetic purposes is a public health problem, for 40 years this problem has been described throughout our continent, the vast majority of women patients are affected by the infiltration of silicon, mineral oils, automotive oil, methyl methacrylate, cement and various oily substances. This is a 54-year-old female patient who for about 30 years for cosmetic purposes was injected with mineral oil (quantity unknown) in both glutei with the aim of buttock augmentation. Physical examination was observed an important deformity in each buttock, hyperkeratosis with discoloration in both buttocks, loss of bilateral projection, right buttock with a secondary tumor of 22 cm × 11 cm and left 22 cm × 10 cm, stony appearance, local hyperthermia, painful on manipulation, with diffuse nodular lesions measuring 2 cm × 2 cm, without evidence of loss of continuity that would condition secretion leakage. Surgical planning is based on the very important size of the initial defect that we would have to reconstruct, so that the rotation of two wide-based flaps could guarantee better survival and occlusion of the defect, since the realization of a graft would cause a significant deformity, and the realization of a microsurgical flap in a fibrous tissue would inevitably result in its necrosis. The pathophysiology of the adjuvant disease is extremely complex, therefore it must be addressed by a multidisciplinary group with extensive experience.

Imaging in Gluteal Hernia

Gluteal hernias are extremely uncommon and occur as a result of deficiency or defect in the gluteal musculature. Our case reports one such incidence in a one year old girl with review of available literature. The clinical presentation and imaging findings are discussed comprehensively. We thus lay emphasis on the importance of real-time ultrasonography as the method of choice to identify hernia contents, peristalsis and obstruction if any.

Transferring superior gluteal nerve to pudendal nerve in reconstructing functional impairment in simple conus medullaris or pudendal nerve injury

Objective: 1Department of Anatomy, College of Basic Medical Sciences, Second Military Medical University, Shanghai 200433, China 2Department of Orthopedic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China Abstract Objective: To study the anatomical basis of transferring the superior gluteal nerve to the pudendal nerve in reconstructing the functional impairment in simple conus medullaris or pudendal nerve injury. Methods: Superior gluteal nerve and pudendal nerve were observed and measured by the gross and microsurgical anatomical methods in 62 sides of 31 adult cadavers. Results: Superior gluteal nerve came out of the superior foreman of piriformis as 1 to 4 branches(29.03%,56.45%,12.90% and 1.61% respectively) and the pelvic-leaving points were mainly in the middle 1/3(85.48%) of the line from the posterior superior iliac spine to the ischial tuberosity. The length of the inferior branch of the superior gluteal nerve was more than 5 cm, and the distance between the pelvic-leaving points of the superior gluteal nerve and pudandal nerve was about 4 cm only. The pudendal nerve left the pelvis mainly in the middle 1/3(48.39%) of the line from the posterior superior iliac spine to the ischial tuberosity,or at the junction of its inferior-middle 1/3(46.77%). In clinic, we have successfully made the operation transferring the superior gluteal nerve to the pudendal nerve in 3 patients suffered from the injury of conus medullaris. Conclusion: Distance between the pelvic-leaving points of the superior gluteal nerve and the pudendal nerve is close, so the inferior branch of the gluteal nerve can be anastomosed with the pudendal nerve directly. Transferring the superior gluteal nerve with higher spinal segemental origin to the pudendal nerve of a lower spinal segemental origin is practical and easy.

深部臀肌综合征的诊治进展

深部臀肌综合征(DGS)是一种非盘源性坐骨神经痛,常由骶髂区和臀区的创伤引起,是坐骨神经穿过深部臀肌间隙时神经干被周围的肌肉卡压引起臀部和髋关节后方疼痛,久坐或长期行走加重,包括梨状肌综合征、闭孔内隐窝综合征、坐骨股骨头撞击综合征和近端腘绳肌综合征等亚型。正确的诊断主要依据病史采集、体格检查(激惹试验、电生理检查)和影像学检查。非手术治疗包括休息、避免激惹疼痛的活动、药物、注射和物理治疗等多学科治疗,对于非手术治疗无效后持续症状或顽固疼痛的患者进行内窥镜或切开手术治疗。本研究总结了DGS的流行病学、解剖、发病机制、分型、临床症状、辅助检查、诊断和治疗,为DGS的治疗提供理论依据。

Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects

Background Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the donor area after harvesting of relatively large flaps carries a risk of postoperative dehiscence. This research was to investigate a modified superior gluteal artery perforator flap for repairing sacrococcygeal soft tissue defects. Methods From June 2003 to April 2010, we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients （study group）. The wound and donor areas were measured, and the flaps were designed accordingly. Wound healing was assessed over a follow-up period of 6-38 months. From January 1998 to February 2003, twelve patients with sacrococcygeal pressure sores were treated with traditional methods, VY advancement flaps or oblong flaps, as control group. Results After debridement, the soft tissue defects ranged from 12 cm× 10 cm to 26 cm× 22 cm （mean 16.3 cm× 13.5 cm）. Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm （mean 18.2 cm × 14 cm）. Four patients were treated using left-sided flaps, and two were treated using both right- and left-sided flaps. Suction drains were removed on postoperative Days 3-21 （mean 5.9） and sutures were removed on postoperative Days 12-14. Each flap included 1-2 perforators for each of the donor and recipient sites. Donor sites were closed directly. All flaps survived. In eight patients, the wounds healed after single-stage surgery. After further debridement, the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33, respectively. The rate of first intention in the study group （80%, 8/10） significantly increased than that of control group （（25%, 3/12）, X2=4.583, P=0.032）. Follow-up examinations found that the flaps had a soft texture without ulceration. In the two patients without paraplegia, the range of motion of the hip joints was not affected. Conclusion The use of the quadrilobed superior gluteal artery perforator flap can overcome the disadvantages of traditional perforator flaps and represents an improved approach for repairing soft tissue defects in the sacrococcygeal region.

SUCCESSFUL RESECTION OF UNUSUAL LARGE HEMANGIOMA OF RIGHT GLUTEAL AND PUBIC REGION

Intramuscular hemangioma usually involues only a single muscle,but it may demonstrate regional involvement and can occasionally grow extremely large.In the latter condition,resection can be very difficult and occasionally lead to fatal uncontrollable bleeding during surgery.

X线、CT及磁共振成像对臀肌挛缩症的诊断价值分析

目的探讨骨盆X线、CT及磁共振成像(MRI)对臀肌挛缩症(GMC)的影像诊断价值。方法回顾性分析2015年8月2021年9月在南华大学附属长沙中心医院经关节镜手术诊断为GMC的41例患者的骨盆X线、CT及MRI检查结果,比较三者对GMC的影像特征。结果X线:41例见髂骨致密线影,14例见骨盆倾斜,9例见脊柱侧弯,3例见双下肢不等长。CT:35例为双侧臀肌挛缩,6例为单侧臀肌挛缩,41例见肌肉间隙增宽,26例见挛缩带,1例见臀肌钙化,27例见髂骨肥厚。MRI:35例为双侧臀肌挛缩,6例为单侧臀肌挛缩,41例均见脂肪信号影增多及肌间隙增宽,41例均见挛缩带。结论髂骨致密线是臀肌挛缩症的重要X线表现,CT能更直观地了解髂骨骨质改变及臀肌挛缩的范围,MRI能直接显示臀肌萎缩部位、范围及挛缩带,对早期指导临床手术治疗有重要意义。

个性化皮瓣修复臀骶周围深度压疮疗效观察

目的:探讨个性化皮瓣修复臀骶周围深度压疮的临床疗效。方法:选择2017年6月-2020年6月笔者医院收治的68例臀骶周围深度压疮患者为研究对象,根据患者创面情况分别采用旋股外侧动脉降支带蒂皮瓣、臀部自由穿支螺旋桨皮瓣及臀下动脉股后皮支复合组织瓣等手术方法修复臀骶周围深度压疮,观察患者疗效。结果:本组68例患者,其中行臀部自由穿支螺旋皮瓣修复32例;旋股外侧动脉降支带蒂(肌)皮瓣修复18例;臀下动脉股后皮支复合组织瓣修复14例;任意皮瓣修复4例。术后皮瓣一期愈合64例,延期愈合4例,其中1例高位截瘫患者患肢痉挛性瘫痪导致皮瓣裂开,经换药后愈合,其他3例皮瓣下淤血伴感染,经再次手术后愈合。术后随访6~12个月,所有患者皮瓣色泽、张力均正常,且耐磨耐压,患者对外观效果均较满意。结论:对臀骶周围深度压疮创面采用个性化皮瓣手术修复治疗,皮瓣血运良好,成活率高,创面修复效果好,对臀骶部外形功能影响小,患者满意率高。

臀上或臀下动脉双叶皮瓣修复老年臀部压疮的效果

目的探讨臀上或臀下动脉双叶皮瓣修复老年臀部压疮的效果。方法回顾性分析2015~2021年我院收治的21例老年臀部4期压疮病人的临床资料,其中应用臀上动脉双叶皮瓣修复13例,臀下动脉双叶皮瓣修复8例。观察病人术后皮瓣血运及成活情况、伤口愈合情况、并发症发生情况;病人出院后,门诊复诊随访观察臀部供区与受区外观及压疮是否复发。结果病人清创或扩大切除后的创面面积为7.5 cm×6 cm~12 cm×10 cm,所有病人皮瓣全部成活且血运良好,无切口裂开发生。20例病人皮瓣Ⅰ期愈合;1例病人术后5 d皮瓣出现一处2 cm×2 cm创面,局部感染沿皮下潜行,经清创、换药,延期缝合后Ⅲ期愈合。随访1~12个月,所有病人臀部供区与受区外形平整,压疮无复发。结论臀上或臀下动脉双叶皮瓣较好地解决了单叶皮瓣供瓣区张力大的问题,皮瓣血运可靠,术后并发症少,臀部供区与受区外形恢复良好,尤其适用于修复伴有动脉血管硬化闭塞的老年臀部压疮。

髋部外侧疼痛之谜——臀肌肌腱病

近年来,臀肌肌腱病被认为是髋关节外侧疼痛的主要原因,严重影响患者生活质量,在临床上尚未引起重视或经常被误诊。就臀肌肌腱病的发病机制、临床特征、临床诊断试验、影像学检查和治疗进展进行综述。

股骨大转子疼痛综合征的临床及MRI表现

目的 探讨股骨大转子综合征(greater trochanteric pain syndrome,GTPS)的MRI表现。方法 回顾性收集我院2020年7月1日至2021年7月1日40例临床诊断为GTPS患者的临床及MRI资料,分析患者股骨转子区滑囊、臀肌肌腱、股骨大转子及髂胫束等解剖结构信号改变。结果 40例患者共累及55髋,其中女性占72.5%,双髋受累15例,临床症状为髋外侧疼痛,主要MRI表现为孤立性转子区滑囊积液、扩张,呈长T1长T2信号(n=40),臀肌肌腱增粗、信号增高(n=13),股骨大转子骨髓水肿(n=2),臀肌肌腱信号局限性中断、缺失(n=2),髂胫束增厚并信号增高(n=1)。结论 GTPS主要见于老年女性,多为单髋受累,MR表现具有一定特异性,准确诊断对临床治疗方案的选择具有一定指导意义。

对比足三里穴位注射胃复安与传统臀部肌内注射治疗急性酒精中毒呕吐的效果研究

目的分析足三里穴位注射胃复安与传统臀部肌内注射治疗急性酒精中毒呕吐的效果。方法方便选择福建三明中西医结合医院2020年1—12月急性酒精中毒呕吐患共100例作为研究对象,按照随机数表法分为两组,每组50例,两组均给予纳洛酮促进苏醒、奥美拉唑抑酸保胃、维生素B6促进酒精新陈代谢。臀部注射组患者在出现呕吐之后,选择药物胃复安,并将其经臀注射。足三里注射组患者在出现呕吐之后,选择药物胃复安,并将其经足三里穴位注射。胃复安2 mL(10 mg)加双侧足三里穴位注射,每侧穴位1 mL后30 min观察疗效。比较两组急性酒精中毒呕吐持续时间、意识状态恢复清醒时间、疾病总转归率。结果足三里注射组急性酒精中毒呕吐持续时间、意识状态恢复清醒时间为(3.21±1.21)d、(3.21±0.24)d短于臀部注射组的(5.22±1.31)、(6.21±1.12)d,差异有统计学意义(t=7.970、18.520,P<0.05)。足三里注射组疾病总转归率为100.00%高于臀部注射组,差异有统计学意义(P<0.05)。结论采取足三里穴位注射胃复安治疗干预对于急性酒精中毒呕吐的治疗效果确切,其应用有利于加速呕吐消失,并改善急性酒精中毒呕吐患者的意识状态,可缩短整体治疗时间。

慢性臀部肌筋膜炎误诊为腰椎间盘突出症的原因分析及防范对策

目的:分析慢性臀部肌筋膜炎误诊为腰椎间盘突出症的原因及防范对策。方法:回顾性分析2019年1月—2020年6月河北省临漳县中医院康复疼痛科门诊收治的160例慢性臀部肌筋膜炎被误诊为腰椎间盘突出症患者的临床资料。结果:160例患者经分析、鉴别、触诊、CT或MRI以及肌骨超声检查,确诊为慢性臀部肌筋膜炎,并给予针刀治疗,症状均显著减轻。结论:慢性臀部肌筋膜炎与腰椎间盘突出症常同时存在,误诊率较高,应引起广大临床医师的重视,严格掌握两种疾病的诊断标准,防止误诊、误治的发生。

脂肪移植隆臀相关的臀部美学及脂肪栓塞事件研究进展

脂肪移植隆臀是臀部美容整形的重要手段之一。目前,脂肪移植隆臀不再单纯强调臀部体积的增大,而更关注塑造丰满、协调、流畅的臀部曲线,同时臀部美学的区域单元化和精细化,可有效提高脂肪移植隆臀术的美学效果。此外,脂肪移植隆臀虽有创伤小、术后恢复快、无明显瘢痕、效果佳等优点,但与此相关的脂肪栓塞事件限制了其发展。诊治和预防脂肪栓塞事件、提高手术安全性,是当前临床极为关注的问题。本文就脂肪移植隆臀相关的臀部美学,以及与此相关的脂肪栓塞事件的研究进展进行综述。