臀肌筋膜挛缩症影像学表现

目的探讨臀肌筋膜挛缩症(gluteal muscle contracture, GMC)影像学特点。方法回顾分析388例经临床确诊GMC患者的临床及影像学资料。388例术前行骨盆X线及CT检查,其中2例行双侧髋关节MRI检查。378例接受手术治疗,其中129例术后行CT检查,3例行MRI检查。结果患者主要临床表现为髋关节弹响、活动受限及并脚下蹲困难。X线:373例(96.1%)见骨盆致密线;CT:388例(100%)见臀肌"挛缩带"、臀肌萎缩;MRI:2例(100%)见双低信号臀肌"挛缩带"。70例(18.0%)见骨盆倾斜。臀大肌挛缩产生骨盆致密线,臀中肌挛缩导致髂骨外翻。术后CT及MRI见臀肌挛缩带中断。结论 GMC在CT或MRI检查可见特征性臀肌"挛缩带",指导临床治疗并进行术后影像学评估。     

臀肌挛缩症与髂骨致密性骨炎的关系

目的：探讨臀肌挛缩症（GMC）与髂骨致密性骨炎（OCI）的关系。方法：搜集我院手术确诊的符合本研究纳入标准的GMC患者共315例,非GMC对照组251例,由2位高年资的放射诊断医师阅读两组的术前CT影像资料,分别统计OCI的发生率。随机选取不对称性OCI的GMC患者资料19例,共累及23侧骶髂关节,测量OCI髂骨硬化区与臀大肌,并进行相关性分析。结果：GMC组中OCI 81例（25.7%）,其中男16例（16/315）,女65例（65/315）;对照组251例中有2例OCI（0.7%）。GMC组与对照组之间及GMC组内男女患者之间,OCI的发生率差异均有显著性意义,U值分别为7.42,4.52,P〈0.05。OCI髂骨硬化程度与臀大肌的相关分析表明二者呈正相关r=0.61,P〈0.01。结论：GMC与OCI有密切关系。     

骨盆畸形致髂骨致密性髂骨炎样改变（附小儿麻痹后遗骨盆畸形1…

目的：探讨骨盆畸形后髂骨致密性髂骨为改变的原因，材料与方法，分析了１６０例小儿麻痹后后遗骨盆畸形的骨盆Ｘ线片及其中２例的骨盆ＣＴ片，另８５例正常人作对照。结果：小儿麻痹组５７例一组，１例两侧共５８例有致密髂骨炎样改变（３６．３％），正常组亦有２例（２．３％），骨盆ＣＴ示上述致密改变是骶髂关节髂骨面中前部的骨质增多，增厚致正常小三角形致密影明显增大，而骨质正常，结论，本组病例的致密性髂骨炎样改变是小     

骨盆畸形致髂骨致密性髂骨炎样改变(附小儿麻痹后遗骨盆畸形160例分析)

目的：探讨骨盆畸形后髂骨致密性髂骨炎样改变的原因。材料与方法：分析了１６０例小儿麻痹后遗骨盆畸形的骨盆Ｘ线片及其中２例的骨盆ＣＴ片，另８５例正常人作对照。结果：小儿麻痹组５７例一侧，１例两侧共５８例有致密性髂骨炎样改变（３６．３％），正常组亦有２例（２．３％）。骨盆ＣＴ示上述致密改变是骶髂关节髂骨面中前部的骨质增多、增厚，致正常小三角形致密影明显增大，而骨质正常。结论：本组病例的致密性髂骨炎样改变是小儿麻痹后遗骨盆畸形向一侧偏歪、负重，骨盆力学结构变化，骨质按力学的Ｗｏｌｆｆ定律增生形成的一种Ｘ线征象     

小儿骶髂关节外伤的CT表现

小儿骶髂关节外伤的CT 表现以往未见报导。文内报告6例,通过骶髂关节做5mm 层厚相邻层面CT 扫描、CT 随访及常规X 线照片。成长期骶髂关节外伤性分离可合并不常见的表现:半侧骨盆成长不良,相继出现骶髂关节融合及骨盆畸形伴肢体长度不等。本组5个小儿外伤后具骶髂关节间隙增宽X 线征者中仅一侧得到CT 证实。其中3例有CT 表现,而关节间隙本身无损。第5个病例在CT 上关节间隙正常,但双侧受累的骶髂关节都不规则。第6例的骶髂关节平片完全正常,但CT 显示左骶髂关节变窄。小儿外伤后伴软骨下骨折的即时CT 扫描可显     

强直性脊柱炎骶髂关节病变的影像学研究

分析了43例正常骶髂关节CT表现并对30例强直性脊柱炎(AS)骶髂关节病变作了双盲X线和CT对照研究,正常成人滑膜部关节间隙宽度为2～5mm,40岁后,关节前下部间隙可出现局部狭窄,骶侧皮质厚度多小于3mm,前后均匀者占90%;髂侧中部皮质厚度小于5mm,其前部皮质厚度可大于5mm(占16%),部分正常人可出现关节面不清晰,但无明确的侵蚀改变,关节面的侵蚀是诊断早期骶髂关节炎的重要条件,AS骶髂关节病变的对照研究表明:对平片可疑的病变,CT常可排除或肯定诊断,早期病变(Ⅱ级),CT可提高一个级别;Ⅲ、Ⅳ级病变CT和平片分级相同.CT扫描可用于临床高度怀疑而平片难以确诊者;对Ⅲ、Ⅳ级病变如仅为诊断,则CT扫描似并非必需.     

骶髂关节正斜位片在强直性脊柱炎（Ⅱ级以上）X线诊断中的应用价值

目的：评价骶髂关节正斜位片在强直性脊柱炎（Ⅱ级以上）X线诊断中的价值。资料和方法：根据目前常用强直性脊柱炎的纽约诊断标准，对临床上已确诊的120例强直性脊柱炎患者骶髂关节正斜位片与CT片进行对照分析。结果：X线组（60例）：阳性者49例，阴性者11例，阳性率为81．7％；CT组（60例）：阳性者55例，阴性者5例，阳性率为91．7％。结论：虽然对于强直性脊柱炎的诊断，X线组阳性率81．7％低于CT组阳性率91．7％，但二者的结果经统计学分析无显著性差异，故笔者认为X线检查中的骶髂关节正斜位片对于强直性脊柱炎（Ⅱ级以上）诊断可以达到与CT检查基本相同的阳性率。     

骶骨损伤的CT诊断

作者由CT扫描发现了88例骶骨骨折或骶髂关节损伤。每例均有伤后所摄的前后位骨盆X线片,有的还摄有斜位片及倾斜角度的X线片。CT在外伤后七天内进行。作者将CT所见到的骶骨及骶髂关节损伤分为四种基本类型。第一型为骶髂关节分离,占骶骨损伤的39％,X线平片初诊漏诊率为29％,回顾性复习时漏诊率为26％。CT表现为关节不对称与间隙增宽。第二型为骶骨或髂骨唇部骨折,占骶骨损伤的25％,X线平片初诊漏诊率为57％,回顾性复习时漏诊率为59％。CT图象可见到骶骨或髂骨唇部骨折线累及骶髂关节面,但不累及骶骨的神经孔。第三型为骶骨纵行骨折,占骶骨损伤的25％。X线平片初诊漏诊率为34％,回顾性     

骶髂关节结核X线表现与鉴别诊断(附31例分析)

目的：探讨骶髂关节结核的X线表现及与其他病变的鉴别诊断。资料与方法：搜集31例经手术、病理证实的骶髂关节结核，并对其X线表现及鉴别进行了分析。结果：右侧17例（55％），左侧12例（39％），双侧2例（6％）。典型X线表现：（1）骨型骶髂关节结核呈圆形或椭圆形破坏区，并累及髂骨侧关节面。（2）滑膜型骶髂关节结核呈：①关节面模糊、糜烂，骨质破坏，关节间隙狭窄或不规则增宽；②大块死骨或散在颗粒状高密度影；③骨质增生硬化。结论：骶髂关节结核的X线表现有一定的特征性，传统X线片仍不失为首选的检查方法。     

强直性脊柱炎致骶髂关节炎的X线与CT诊断

目的 评估X线对强直性脊柱炎患者骶髂关节炎的诊断价值。方法 对临床表现为缓慢加重的腰骶部及双髋部疼痛、压痛及活动受限者68例，进行脊柱正侧位或加摄斜位X线片。其中，6例临床怀疑骶髂并节病变者又经CT检查。结果 单侧骶髂关节改变为28例，双侧骶髂关节改变40例。怀疑骶髂关节病变6例，轻度骶髂关节炎34例，中度骶髂关节炎20例，重度骶髂关节炎8例。68例中59例HLA—B27抗原阳性。结论 X线正位加左、右斜位平片能对大部分骶髂关节炎作出诊断，尤其是左、右斜位更有利于观察骶髂关节病变。对于骶髂关节炎的早期诊断，CT优于X线平片。     

儿童臀肌挛缩症的CT诊断

目的探讨儿童臀肌挛缩症的CT表现。方法对6l例经CT诊断为臀肌挛缩症，并经手术病理证实的患儿进行研究，并与20例正常臀肌的CT表现作对照。结果在61例臀肌挛缩症中，57例(93．4％)是双侧挛缩，4例(6．6％)是单侧；CT主要表现：(1)臀肌体积缩小，118侧(100．0％)臀大肌体积缩小，16侧(13．6％)臀中肌体积缩小；12侧(10．2％)梨状肌体积缩小；4侧(3．4％)臀小肌体积缩小；4侧(3．4％)髋关节后方关节囊挛缩。(2)注射点区臀肌钙化、坏死。95侧(80．5％)臀肌有钙化，24侧(20．3％)臀肌有斑片状坏死。(3)条索状挛缩带，81条位于臀大肌外侧，从臀大肌外上缘到髂筋束，36条位于臀大肌骶骨侧。(4)肌间隙增宽，轻度38侧(32．2％)，中度53侧(44．9％)，重度27侧(22．9％)。结论CT扫描能正确诊断臀肌挛缩症，明确病变范围及程度，对术前评估有重要价值。     

MRI diagnosis of contracture of the gluteus maximus muscle

OBJECTIVE: The objective of our study was to describe MRI features of contracture of the gluteus maximus muscle after providing a retrospective review of the MRI studies of 21 patients. CONCLUSION: Gluteal contracture manifests characteristic features on MRI, including an intramuscular fibrotic cord extending to the thickened distal tendon with atrophy of the gluteus maximus muscle and posteromedial displacement of the iliotibial tract. In advanced cases, medial retraction of the muscle and its tendon results in a depressed groove at the muscle-tendon junction and external rotation of the proximal femur. Clinical correlation and meticulous physical examination may confirm the MR diagnosis.     

Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients

Objective. To report the imaging findings in nine patients who developed pelvic instability after bone graft harvest from the posterior aspect of the iliac crest. Design and patients. A retrospective study was performed of the imaging studies of nine patients who developed pelvic pain after autologous bone graft was harvested from the posterior aspect of the ilium for spinal arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis were reviewed. Pertinent aspects of the clinical history of these patients were noted, including age, gender and clinical symptoms. Results. The age of the patients ranged from 52 to 77 years (average 69 years) and all were women. The bone graft had been derived from the posterior aspect of the iliac crest about the sacroiliac joint. All patients subsequently developed subluxation of the pubic symphysis. Eight patients had additional insufficiency fractures of the iliac crest adjacent to the bone graft donor site, and five patients also revealed subluxation of the sacroiliac joint. Two had insufficiency fractures of the sacrum and one had an additional fracture of the pubic ramus. Conclusions. Pelvic instability is a potential complication of bone graft harvesting from the posterior aspect of the iliac crest. The pelvic instability is manifested by insufficiency fractures of the ilium and subluxation of the sacroiliac joints and pubic symphysis. Received: 25 January 2000 Revision requested: 22 May 2000 Revision received: 15 September 2000 Accepted: 4 January 2001     

髂胫束松解治疗臀肌挛缩症

目的为了寻求治疗臀肌挛缩症更加简单、安全、有效的手术方法,了解该病的发病因素和股骨大转子部髂胫束的病变情况。背景目前大部分作者认为臀肌挛缩症是臀部肌肉注射引起并与患者遗传因素有关的一种疾病,治疗方法多采用臀部切口,对臀大肌、臀中肌、臀小肌中的挛缩组织进行松解,以改善患侧髋关节的内收与内旋。此方法切口大、出血多、创伤大,有损伤坐骨神经和术后引起髋外展肌无力的危险。方法作者采取于股骨大转子部“Z”字形切断髂胫束的方法,使臀部紧张组织松弛,缓解患者症状。术后随访了连续治疗的33例患者,随访时间1～6年半,平均2.6年。结果本文所采取的手术方法操作简单、出血少,无严重合并症,所有病人手术效果均满意,是治疗该症较理想的方法之一,并发现创伤也是造成该症的另一因素。强调手术时彻底松解紧张的髂胫束和部分紧张的臀大肌止点是手术成功的关键。     

Hip abductor muscle activity during walking in individuals with gluteal tendinopathy

The external hip adduction moment during walking is greater in individuals with gluteal tendinopathy (GT ) than pain‐free controls. Although this likely represents a greater demand on the hip abductor muscles implicated in GT , no study has investigated activation of these muscles in GT . For this purpose, fine wire electrodes were inserted into the segments of the gluteus minimus and medius muscles, and surface electrodes placed on the tensor fascia lata, upper gluteus maximus, and vastus lateralis muscles of eight individuals with, and eight without, GT . Participants underwent six walking trials. Individual muscle patterns were compared between groups using a wavelet‐based linear effects model and muscle synergy analysis performed using non‐negative matrix factorization to evaluate muscle activation patterns, within‐ and between‐participant variability. Compared to controls, individuals with GT exhibited a more sustained initial burst of the posterior gluteus minimus and middle gluteus medius muscle segments. Two muscle synergies were identified; Synergy‐1 activated in early‐mid stance and Synergy‐2 in early stance. In GT participants, posterior gluteus minimus and posterior gluteus medius and tensor fascia lata contributed more to Synergy‐1 active during the period of single leg support. Participants with GT exhibited reduced within‐participant variability of posterior gluteus medius and reduced between‐participant variability of anterior gluteus minimus and medius and upper gluteus maximus. In conclusion, individuals with GT exhibit modified muscle activation patterns of the hip abductor muscles during walking, with potential relevance for gluteal tendon loading.     

The influence of gluteus maximus on transverse plane tibial rotation

There is a common clinical belief that transverse plane tibial rotation is controlled by the rearfoot. Although distal structures may influence the motion of the tibia, transverse plane tibial rotation could be determined by the proximal hip musculature. Cadaver studies have identified gluteus maximus as having the largest capacity for external rotation of the hip. This study was therefore undertaken to investigate the effect of gluteus maximus on tibial motion. Kinematic data were collected from the foot and tibia along with EMG data from gluteus maximus for 17 male subjects during normal walking. A number of kinematic parameters were derived to characterise early stance phase. Gluteus maximus function was characterised using RMS EMG and EMG on/off times. No differences in muscle timing were found to be associated with any of the kinematic parameters. In addition, no differences in gluteal activation levels were found between groups of subjects who had different amounts of tibial rotation. However, there was a significant difference (p < 0.001) in gluteus maximus activation when groups were defined by the time taken to decelerate the tibia (time to peak internal velocity). Specifically, subjects with greater gluteus maximus activity had a lower time to decelerate the tibia. We suggest that a high level of gluteus maximus activity results in a larger external torque being applied to the femur, which ultimately leads to a more rapid deceleration of the tibia.     

Calcific tendinitis of the gluteus maximus tendon: CT findings

Two cases of calcific tendinitis of gluteus maximus muscle are presented. The CT findings, including amorphous calcification without soft tissue mass and possible cortical erosion at the femoral enthesis of the gluteus maximus muscle, are highly suggestive of calcific tendinitis at this unusual but classical location. Ossifying entheses with well-defined cortical defect are frequent at the femoral insertion of the gluteus maximus muscle in asymptomatic subjects and must be differentiated from a real cortical erosion sometimes associated with these calcific tendinitis. Received: 16 July 1998; Revision received: 14 September 1998; Accepted: 13 October 1998     

The biomechanics of running in athletes with previous hamstring injury: A case‐control study

Hamstring injury is prevalent with persistently high reinjury rates. We aim to inform hamstring rehabilitation by exploring the electromyographic and kinematic characteristics of running in athletes with previous hamstring injury. Nine elite male Gaelic games athletes who had returned to sport after hamstring injury and eight closely matched controls sprinted while lower limb kinematics and muscle activity of the previously injured biceps femoris, bilateral gluteus maximus, lumbar erector spinae, rectus femoris, and external oblique were recorded. Intergroup comparisons of muscle activation ratios and kinematics were performed. Previously injured athletes demonstrated significantly reduced biceps femoris muscle activation ratios with respect to ipsilateral gluteus maximus (maximum difference ?12.5%, P = 0.03), ipsilateral erector spinae (maximum difference ?12.5%, P = 0.01), ipsilateral external oblique (maximum difference ?23%, P = 0.01), and contralateral rectus femoris (maximum difference ?22%, P = 0.02) in the late swing phase. We also detected sagittal asymmetry in hip flexion (maximum 8°, P = 0.01), pelvic tilt (maximum 4°, P = 0.02), and medial rotation of the knee (maximum 6°, P = 0.03) effectively putting the hamstrings in a lengthened position just before heel strike. Previous hamstring injury is associated with altered biceps femoris associated muscle activity and potentially injurious kinematics. These deficits should be considered and addressed during rehabilitation.