关节镜下等离子刀微创治疗成年人注射性臀肌挛缩症

目的 探讨关节镜下微创手术治疗注射性臀肌挛缩症的疗效.方法 2001年6月至2005年6月关节镜监视下等离子刀松解治疗成人注射性双侧臀肌挛缩症患者108例,其中男性57例,女性51例;年龄18～40岁,平均24岁.术前标记股骨大转子与臀肌挛缩带的范围、坐骨神经走行和手术切口.侧卧位,于股骨大转子切口5 mm,在臀肌挛缩带与皮下筋膜组织间钝性分离,制作关节镜手术工作腔隙.刨削刀清理臀肌挛缩带表面脂肪组织.关节镜监视下沿臀肌挛缩带前缘至后方,再沿股骨大粗隆后方,臀肌附着处弧形切断臀大肌挛缩束带.屈髋、内收、内旋髋关节,直到无弹响、无活动受限为止.结果 101例患者获得随访,平均随访时间19个月.术后无复发、感染和神经血管损伤.臀部皮下积液3例,置管负压引流后痊愈.根据臀肌挛缩术后功能评分表,优91例,良7例,可3例.结论 关节镜下等离子刀松解术治疗成人注射性臀肌挛缩症创伤小、痛苦少、操作安全、疗效可靠,有利于早期功能康复.

Arthroscope monitored solution of adult intramuscular injection associated gluteal muscle contracture by radiofrequency

Objectives To evaluate the result of releasing adult intramuscular injection associated gluteal muscle contracture under the monitor of arthroscope by radiofrequency probe.Methods From June 2001 to June 2005,108 cases of bilateral gluteal muscle contracture were treated with radiofrequency colation under the arthroseope and solution with an average age of 24 years(from 18 to 40 years).There were 57 males and 51 females.Preoperatively,the course of the outline of the femur greater trochanter the sciatic nerve in buttocks and the area of gluteal muscle contracture were marked.With the patients firmly anchored in the straight lateral position,normal saline(which contains Adnephrin)was injected between the surface of contracted gluteus and subcutaneous fat to reduce bleeding in operation.The ports for the motorized shaver and radiofrequency probe were located at the edge of gluteal muscle contracture and were 5 mm superior to the greater trochanter.The 6 mm diameter port for the arthroscope was 3 cm inferior to the greater trochanter.Space was made between contracture bands and overlying subcutaneous tissue with a periosteal elevator by blunt dissection.After the anterior and posterior edge of the contracture bands were fully revealed,normal saline were filled in the space.With the monitor of arthroscope,the procedures were:removing fatty tissue from the surface of the contracture bands with motorized shaver,then cutting off the contracture bands curvedly and carefully probing and cutting off contracture bands which were mixed in gluteus myolins with radiofrequency probe,finally hemostasis by radiofrequeney probe.In the operation flexion,adduction,internal rotation and straightening hip joint were repeated,until it got normal range of motion without snap and bleeding.Results One hundred and one patients were followed up with an average of 19 months.According to a comprehensive evaluating system,91 cases were excellent,7 were good,and 3 were fair.No infection,recurrence and neurovascular injury occurred.Conclusions Gluteal muscle contracture could be effectively released with radiofrequency vaporization and solution.The technique has the advantage of easy to manipulate,minimally invasive,painless,safety and reliable curative effect,and is good for early functional exercises.