摘要
目的探讨关节镜监视下等离子刀松解臀肌挛缩的疗效。方法回顾我院2015年5月至2017年5月在关节镜监视下进行臀肌挛缩松解的病人,对其中随访资料完整者19例进行总结分析。手术采取侧卧位,两侧依次手术。在股骨大粗隆最隆起处后缘、其后上方约5 cm处分别做切口,切口长约0.8 cm。用关节镜钝性穿刺头沿深筋膜浅层向大粗隆前方穿刺,分离皮下组织,形成关节镜工作腔隙,插入关节镜及器械,在关节镜监视下用低温等离子刀松解。第一步从大粗隆后方斜向前方切断髂筋束,第二步切断臀大肌止点的上半部,然后屈伸髋关节检查松解效果,若仍不满意,进行第三步松解,沿臀大肌纤维向近端剥离,找到肌肉纤维内的疤痕挛缩带,松解切断,直至阳性体征消失。结果切口均Ⅰ期愈合,无血管神经损伤等严重并发症。术后随访3~12个月,参照刘国辉提出的臀肌挛缩术后功能综合评价标准,优15例,良4例,中0例,差0例。术后三个月对患者进行满意度调查,非常满意2例,满意15例,一般2例,不满意0例。结论关节镜下松解臀肌挛缩创伤小,恢复快,效果满意,是治疗臀肌挛缩的有效微创手术方式。
Objective To investigate the effect of gluteal muscle contracture released under arthroscopy guidance. Methods From May 2015 to May 2017, there are 19 patients with gluteus contracture operated under arthroscopy guidance, which were followed up completely and were chose to be summarized and analyzed. Surgery was performed on either side of the hip. There are two incisions that both are about 0.8 cm in length. One incision was made at the posterior margin of the largest bulge of the femur. Another one is 5 cm far from the first. We used arthroscopy blunt needle to puncture along the shallow of fascia. Then we separated subcutaneous tissue, got a lacuna for working, inserted the arthroscopy and instruments, released the tissue by low temperature plasma under arthroscopy monitoring. At first we cut the tissue from posterior of great trochanter to front, cut iliac muscle bundle ahead, The second step is releasing the upper half of glutes ending. Then we bent and stretched hip to check the result of release. If it is not satisfied, we should do the third step to release. Then we buttock big muscle fibers proximally, find the muscle fibers in the scar contracture, cut off, until the positive signs disappeared. Results All incisions are healed with Ⅰlevel without complications such as hematoma,nerve damage. After postoperative follow-up of 3 ～ 12 months, the comprehensive evaluation criteria of postoperative function of gluteal muscle contracture, which was proposed by Liu Guohui, were evaluated, 15 cases are excellent, 4 cases are good. There is no bad case. We investigated the satisfaction rate on three months after operation. 2 patients were very satisfied, 15 patients were satisfied, 2 patients were just so so, no patient was not satisfied. Conclusion Releasing gluteal muscle contracture under the guidance of arthroscopy is minimally invasive, rapid recovery and resulting satisfaction, which is an effective way to treat gluteal muscle contracture.
作者
喻德富
余润泽
沈政
张彪
陈涛
陈鹏
Yu Defu;Yu Runze;Sheng Zheng(Department of Joint Surgery,Anhui No.2 Provincel People＇s Hospital,Hefei Anhui,230041,China)
出处
《生物骨科材料与临床研究》
CAS
2018年第4期50-52,共3页
Orthopaedic Biomechanics Materials and Clinical Study
关键词
关节镜
臀肌挛缩
微创
Athroscopy
Gluteal Muscle Contracture
Minimally Invasive
