基于标准臀肌注射点相对安全区的微创臀肌挛缩症皮下松解术初探

目的：探索一种基于标准臀肌注射点的臀肌挛缩症经皮挛缩松解切口部位选择方案。方法：2008年9月至2010年8月,对25例臀肌挛缩症进行研究,男14例,女11例;年龄12～26岁,平均16.5岁;病程6～12年。所有患者可在臀部触及明显挛缩束带,体表描出髂前上棘-尾骨连线（AD线）和挛缩束带的前后两边缘线（a线,p线）,以连线法定出标准臀肌注射点（即AD连线中外1/3处的O点）,测量a、p两线与AD线交点（B、C点）到O点的距离。并试以C点为皮肤入口点行经皮挛缩松解术。结果：OB距离（0±0.76）cm,OC距离（2.86±0.78）cm,BC距离（2.86±1.01）cm,术后平均手术引流量小于10ml,无神经损伤、术后血肿等并发症,患者4～6d可以良好进行并膝下蹲,康复出院。结论：基于标准臀肌注射点的臀肌挛缩症经皮微创治疗方案,定位准,易掌握,安全可靠。

The first exploration of a minimally invasive lysis subcutaneouly for the treatment of gluteal muscle contracture based on relatively safe region around standard injection point of gluteal muscle

Objective: To explore the solution of choosing the minimally invasive incision site for gluteal muscle contracture patient based on standard injection point of gluteal muscle. Methods: from September 2008 to August 2010,25 patients(14 males and 11 females with an average of 16.5 years,ranging from 12 to 26 years) with injected gluteal muscle contracture were prospectively studied. The course of disease was from 6 to 12 years. Firstly,the connective skin Surface line from anterior superior iliac spine to coccyx (line AD) was delineated and the point (point O) was marked out as the standard gluteal muscle injection site which was on the one-third of the distance from the anterior superior iliac spine(point A) to the coccyx(point D). Secondly,the anterior and posterior edge lines of surface projection of the gluteal muscle contracture banding(line a,line p) were delineated. Thirdly,the distance from B to O and C to O (B is the point of intersection of line a and line AD,C is the point of intersection of line P and line AD)were measured which was the intersection of line a,p and line AD to point O. Lastly,the minimally invasive surgery was operformed via the skin entry of point C. Results: OB=(0±0.76) cm,OC=(2.86±0.78) cm,BC=(2.86±1.01) cm,the mean postoperative drainage was less than 10 ml,there was no nerve damage,hematoma and other complications. All patients achieved the function of squatting in 4 to 6 days. Conclusion: The solution of choosing the minimally invasive incision site based on standard injection point of gluteal muscle has advantages of positioning precisely,handling easily,recoverying quickly,less trauma and safety,etc.