臀肌松解、臀大肌止点肌腱“Z”字延长术治疗复发性臀肌挛缩症

目的分析臀肌筋膜挛缩症术后复发的原因,探讨再次行臀肌筋膜松解术并臀大肌止点肌腱"Z"字延长术的临床效果。方法 2007年1月~2012年12月共收治臀肌筋膜挛缩症术后复发患者15例(24侧),分析其术后复发原因,均采用臀肌筋膜松解+臀大肌止点肌腱"Z"字延长术再次手术治疗。结果本组病例术后复发的原因:3例(6侧)诊断及分型错误,9(14侧)例手术方式的选择不当,3例(4侧)术后未进行功能锻炼。本组患者均获随访,平均时间1.8年(8月~3年)。术后疗效评价:优13例(21侧),良2例(3侧),优良率达100%,效果满意。结论臀肌筋膜挛缩症术后复发原因诸多,术者应掌握臀肌筋膜挛缩症的诊断、分型,熟悉解剖;选择恰当的手术方式,术中彻底松解,可获得满意的活动度,必要时进行臀大肌止点肌腱"Z"字延长术是手术成功的关键。

The Treatment of Gluteal Tendon Release plus Z-shape Elongation of Gluteus Maximus Ending Point for Recurrent Gluteal Muscle Contracture

Objective To analyze the recurrence causes of gluteal muscle contracture and to explore the effect of gluteal tendon release and Z-shape elongation of gluteus maximus ending point. Method 15 patients （24 hips） with gluteal muscle eontracture recurrence admitted from January 2007 to December 2012 were performed gluteal tendon release and Z-shape elongation of gluteus maximus ending point. Results The recurrence causes were mis-diagnosis and classification in 3 cases （6 hips）, inappropriate surgical procedures in 9 cases （ 14 hips） and non-functional exercise in 3 cases （4 hips）. All cases were followed up for 8 months to 3 years with an average of 1.8 years. The outcomes showed excellence in 13 cases （21 sides） , good in 2 cases （3 sides）, and the fineness rate was 100%. Conclusions The recurrence of gluteal muscle contracture has many causes. The satisfied effect can be achieved by appropriate diagnosis and classification, familiar anatomy, suitable surgical approach and complete release. The Z-shape elongation of gluteus maximus tendon ending point is the key to successful operation.