Summary: The operation methods, clinical classification, postoperative function exercise of gluteal muscles contracture were investigated. Clinically and retrospectively, treatment of 1280 patients with gluteal muscle...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.展开更多
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 patie...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.展开更多
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 pirifor...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.展开更多
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, rhabdo...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.展开更多
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 in...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.展开更多
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 clin...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.展开更多
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...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.展开更多
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 don...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.展开更多
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 occasion...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.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
基金This work was supported by a grant from the National Natural Science Foundation of China (No. 30971128).
文摘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.
文摘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.