57例儿童重度臀肌挛缩的诊治分析

目的 探讨小儿重度臀肌挛缩的诊断依据以及治疗方法。方法 回顾性分析57例儿童重度臀肌挛缩的病理和临床特点以及手术方法上与常见型臀肌挛缩的区别。手术强调彻底松解所有影响髋关节活动的肌肉和组织。故不仅要常规切断挛缩的臀大肌，髂胫束与阔筋膜张肌。更关键的是一定要同时切断夹杂在臀中、臀小肌内的挛缩肌束以及挛缩增厚的髋关节囊后半部分，有些甚至需要切断挛缩的梨状肌。结果 57例114侧全部经手术治愈。术后少部分病例有下肢不等长，关节弹跳等并发症。但经1年—2年正确功能训练后，均恢复正常。本组病例无再手术者。结论 重度型儿童臀肌挛缩其临床症状、病理改变较常见型更严重、更广泛。手术彻底松解所有影响髋关节活动的挛缩组织，即能达到较好的效果。

Experience of Diagnosis and Treatment for the Serious Gluteal Muscular Contracture in Children, 57 Cases Reported

Objectire To study the criterion of diagnosis and measures of treatment for the serious gluteal muscular contracture in children.Methods To review57cases charts and research the difference between serious gluteal muscular contracture and commom gluteal muscular contrature in pathology,clinical characteristics and surgical mode.it must be stressed on relaxation of muscules and tissues affecting the movement of hip joint,it is enough to loose n spasmodic glutaus majority,iliotibial fasciculi and tensor fascia lata.However,in severe gluteal muscular contracture must sever all spasmodic muscules which were implanted into meddle glutaeus,least glutaeus and posterior parts of joint sac,even contractured piriformis muscules simultaneously in a few cases.Resucts57cases(114sides)were cured by operation.Some cases may present complication,such as it is different for the length of both legs and arthrodia,but the symptoms can be disolved by the correct exercise after one or fwo years.No reperted surgical cases was seen.Conclusion The children with serious gluteal contracture is more seriously and extensive than those of the children with common gluteal contracture in clinical symptom and pathological characterstics.Relaxing all contracture tissue affecting the movement of hip joint could obtain satisfactory effect.