臀肌攣縮癥

臀肌攣縮的關(guān)節(jié)鏡松解。這位同行兄弟要求拍個(gè)小視頻留念。這里簡(jiǎn)單介紹一下臀肌攣縮的關(guān)節(jié)鏡微創(chuàng)松解，也是我們這里的特色技術(shù)。采用獨(dú)創(chuàng)雙后側(cè)入路，整個(gè)手術(shù)5分鐘即可解決，僅松解攣縮帶，取得了非常好的臨床效果，但是一半靠手術(shù)，另一半要靠努力康復(fù)鍛煉。后續(xù)要好好努力鍛煉了！

臀肌攣縮癥，盡管一系列癥狀都很典型，但對(duì)不熟悉這個(gè)疾病的人來(lái)說(shuō)，不管是醫(yī)生還是患者，有時(shí)候還很難確診。什么是雙皮質(zhì)征呢？?jī)和瘯r(shí)臀肌注射苯甲醇等藥物形成的攣縮帶，不能和骨骼同步生長(zhǎng)，反而將骨盆拉變形。具體表現(xiàn)有髂骨外翻、骨盆后傾、髖關(guān)節(jié)總體外翻、股骨外旋和會(huì)陰（恥骨聯(lián)合）凸起等。其中骶髂關(guān)節(jié)附近的髂骨外板內(nèi)陷與X線平行，遮擋更多的X線，在膠片上就形成白線。這也是確診臀肌攣縮癥的客觀依據(jù)之一。

袁鋒主任門(mén)診時(shí)間：六院臨港院區(qū):周二下午特需門(mén)診2樓8號(hào)間周三上午專(zhuān)家門(mén)診2樓9號(hào)間六院徐匯院區(qū):國(guó)家骨科醫(yī)學(xué)中心8號(hào)樓周三下午特需門(mén)診3樓3號(hào)間周五全天專(zhuān)家門(mén)診2樓13號(hào)間首選公眾號(hào)預(yù)約:上海市第六人民醫(yī)院互聯(lián)網(wǎng)醫(yī)院上海市第六人民醫(yī)院東院微官網(wǎng)備注：如遇滿(mǎn)號(hào)可在門(mén)診日上午8點(diǎn)或下午1點(diǎn)診室門(mén)口排隊(duì)找助理加號(hào)（號(hào)源有限請(qǐng)盡早）徐匯院區(qū)：宜山路600號(hào)臨港院區(qū)：環(huán)湖西三路222號(hào)溫馨提示：就診請(qǐng)?zhí)崆瓣P(guān)注公眾號(hào)出診時(shí)間

關(guān)節(jié)鏡下大轉(zhuǎn)子周?chē)鶦形松解治療臀肌攣縮（2021）ArthroscopicC-ShapedReleaseAroundtheGreaterTrochanterforGlutealMuscle?Contracture?TangX,QiW,LiuY,XiangY,ZhangB,LiH,LiZ,WangZ,WangD,LiC.ArthroscopicC-ShapedReleaseAroundtheGreaterTrochanterforGlutealMuscle?Contracture[J].OrthopSurg,2021,13(6):1765-1772.?轉(zhuǎn)載文章的原鏈接1：https://pubmed.ncbi.nlm.nih.gov/34351059/?轉(zhuǎn)載文章的原鏈接2：https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8523753/?AbstractObjectiveToinvestigatetheoutcomesofC‐shapedreleasearoundthegreatertrochanteringlutealmusclecontractureunderarthroscopy.?MethodsFromDecember2016toJanuary2018,185patientswithglutealmusclecontracturewhotreatedunderarthroscopywerereviewed,including69malesand116females.Allpatientshadahistoryofrepeatedintramuscularinjectionintothebuttocks.Thefollowsignswerepositiveinallthepatientsbeforesurgery:squattingandcrouchingdisability,difficultyincrossingtheleg,Ober'ssignpositive,clickingsoundduringrotationofthehip.TheC‐shapedreleasearoundthegreatertrochanterunderarthroscopywasperformedin96cases(C‐shapedreleasegroup)withanaverageageof24.6±?4.9?yearsold,andconventionalglutealmusclecontracturereleaseunderarthroscopywasperformedin89cases(conventionalreleasegroup)withanaverageageof25.1±?5.0?years.ThereleasedtissuesintheC‐shapedreleasegroup:iliotibialband(ITB)about5?cmdistaltotheproximalendofthegreatertrochanter,thecontracturetissueneartheposteriorandsuperiorofthegreatertrochanter,whichdependedonbothintraoperativephysicalexaminationandarthroscopicobservation.Thereleasedtissuesinconventionalreleasegroup:thecontracturetissuesinglutealmusclesaccordingtoobservationunderarthroscopy.Theglutealmusclecontracturedisabilityscale(GDS)andVisualanaloguescale(VAS)wereevaluatedbeforesurgeryandatthelastfollow‐up.?ResultsTheaveragereleasetimeaftermakingarthroscopicoperationspaceforeachlowerlimbwere12.2±?3.2minintheC‐shapedreleasegroup,and21.4±?6.1minintheconventionalreleasegroup(P=?0.000).Allthepatientswerefollowedforatleastof2?yearsafteroperation.TherewasonecaseofwoundhematomaintheC‐shapedreleasegroupandfivecasesintheconventionalreleasegroup(P=?0.079),abductorweakness(IVlevel)occurredintwopatientsintheC‐shapedreleasegroupandfivecasesintheconventionalreleasegroup(P=?0.208).GDSwas49.3±?17.3(22to70)intheC‐shapedreleasegroupand48.1±?15.6(23to69)intheconventionalreleasegroupbeforesurgery(P=?0.622),91.7±?5.2(83to100)intheC‐shapedreleasegroupand90.2±?6.1(83to98)intheconventionalreleasegroup(P=?0.073)withdifferencenearlysignificantatlastfollow‐up.?ConclusionArthroscopicC‐shapedreleasearoundthegreatertrochanterhadlessoperationtime,acceptablecomplicationoccurrence,andithasanoptimisticoutcomeforglutealmusclecontractureunderarthroscope.?Keywords:Arthroscopy,Disability,Glutealmusclecontracture??ThetargetareaofarthroscopicC‐shapedreleasewasformedbytheiliotibialbandtissue5?cmdistaltotheproximalendofthegreatertrochanter(A),thecontracturetissuenearlyposterior(B)andsuperior(C)ofthegreatertrochanter.??IntroductionGlutealmusclecontractureismostlycharacterizedbythecontractureofglutealmuscles,iliotibialband(ITB)andrelatedfascia,theacquiredglutealcontractureisgenerallyconsideredtobecloselyrelatedtorepeatedintramuscularinjectionofthebuttocksinchildhood1.Glutealmusclecontractureismainlyfoundinadolescents,andmanifestedaspoorposture,restrictedsquattingandcrouching,positivecrosslegtest,positiveObertestandpositive“4”test2.Thecontractualtissueanditsscopecanbeexploredbyultrasound,magneticresonanceimagingandotherexaminationmethods1,3.Ourteamfirstreportedthearthroscopicglutealmusclecontracturereleasein20094,whichhadobviousadvantagesovertraditionalopensurgery,andhadbeenwidelyusedasoneofthemainminimallyinvasivetreatmentmethods5,6.Varioustypesofglutealmusclecontracturewerereported,cablestripcontracture,fanshapedcontracture,mixedcontracture,andtensorfasciaelataecontracture7.Thus,thelocationanddegreeofthecontracturesvariedinpatients,sometimessurgeonswastedtimetofindallthecontracturesinthemusclestoreleaseunderarthroscopy,whichcouldhaveextensiveinterferenceinnormalmuscletissue,andinsufficientreleasemighthappeniftheoperationproceduredependedonlimitedexaminationandevaluation.Meanwhile,complicationsweresometimesreportedforeitherarthroscopicoropensurgery:muscleweakness,surgicalhematoma,neurovascularinjury,whichrelatedtoabundantmuscletissue,regionalnerveandvasculartissueinanatomyofsurgicalarea8,9,10.Rencently,somecontracturereleasemethodswerereportedtoovercometheshortagesofprevioustechniques.Raietal.describedareleasemethod,includingFreleaseinITBandgluteusmaximus,andCreleaseindeeperstructures.Thistechniquehadsmallsurgicaltraumaandhighcosmeticsatisfactionwhencomparedtoopensurgery,butalsohadcomplicatedprocedureinrespectivelysuperficialanddeepertissue.Moreover,ithadnoindividuationforeachpatient,whichmightleadtoexcessiveorinsufficientrelease8.Zinietal.usedendoscopicITBreleaseinsnappinghip,thismethodhadsimpleprocedureandobviouseffectiveness,butnotsuitableforallthepatientsespeciallycomplicatedcases,merelyreleasetheITBmightleadtoinsufficientreleaseandresidualsymptomsinsomepatients9.OurteamdesignedaC‐shapedreleasearoundthegreattrochanterunderarthroscopy.Thehypothesiswasaccordingtothefollowingthreepoints.First,thetechniquewasusedaroundthegreattrochanter,wherelessmuscleandneuromusculartissuedistributed,thiswouldcontrolthesurgicalcomplicationandmaketheoperationmuchsafer.Second,theC‐shapedreleasewasformedbythreeanatomicallyconnectedpartswhichwerecloselyrelatedtotheglutealmusclecontractureineachpatient,accordingtointraoperativephysicalexaminationandarthroscopicobservationbesidespreoperativeevaluation.Thiscouldensurethetreatmentoutcomesandcontroltherateofsurgicalcomplication.Finally,intheoperation,theC‐shapedreleasehadaconstanttargetarea,whichtheoreticallymadeiteasiertobeoperateandsavetime.Inthisretrospectivecontrolledstudy,96patientswithglutealmusclecontracturetreatedwithC‐shapedreleasearoundthegreatertrochanter,and89patientstreatedwithconventionalreleaseunderarthroscopywerereviewed.Thepurposeofstudywas:(i)toverifythefeasibilityofthereleasemethod;(ii)toexplorethesurgicaloutcomesincludingoperatingtime,symptomimprovement,andsubjectiveevaluation;and(iii)toobservethecomplications.?MaterialsandMethodsGeneralInformationFromDecember2016toJanuary2018,185consecutivecasesofglutealmusclecontracturehavingITBcontractureornotandtreatedbyarthroscopicreleasewerereviewed,including69malesand116females.Theinclusioncriteria:(i)allpatientswerediagnosedwithglutealmusclecontracturethroughmedicalhistory,symptomsandphysicalexamination,patientswithtypicalclinicalsignsincludingsquattingandcrouchingdisability,difficultyincrossingthelegs,positiveOber'ssign,snapcouldbedetectedinapassivemanner;(ii)allpatientsunderwentC‐shapedreleaseorconventionalreleaseunderarthroscopy;(iii)allpatientshadnotrespondedtoconservativetreatmentforatleast6months,anddailyliveswereobviouslyaffected;(iv)themainevaluationindicatorsincludedoperationtime,Glutealmusclecontracturedisabilityscale(GDS),Visualanaloguescale(VAS),andcomplication.Thisstudywasaretrospectivecase–controlstudy.Theexclusioncriteria:(i)patientswitharticularandextrarticularpathologiessuchashiposteoarthritis,labraltears,femoroacetabularimpingementsyndrome,internalsnappinghip,hipjointinfection,andankylosisofjoint;and(ii)patientswithapreviousoperationofthelowerextremities.FromDecember2016toMay2017,89casesunderwentconventionalglutealmusclecontracturebandreleaseunderarthroscopy(conventionalreleasegroup).FromJune2017toJanuary2018,96casesunderwentC‐shapedreleasearoundthegreatertrochanterunderarthroscopy(C‐shapedreleasegroup).Allthepatientswereoperatedonbythreeseniorsurgeonswhowereinthesameteamatourcenter.ThefunctionofglutealmusclecontracturewasevaluatedbytheGDSandVASbeforesurgeryandatthelastfollow‐up.Theinformedconsentwasprovidedbyeachpatientinthestudy.?SurgicalMethodsTheC‐ShapedReleasearoundtheGreaterTrochanterAnesthesiaandPositionIntheC‐shapedreleasearoundthegreatertrochanterunderarthroscopy,thelateralpositionwasselectedinallthepatients,andepiduralanesthesiawasroutinelyused.Beforesurgery,thehipwasrotatedtotheidealoperationposturewhereITBcontracturecrossedoverthegreatertrochanterwithtension.Intheidealoperationposture,thehipwasalwaysplacedinappropriateflexion,adductionandinternalrotation.Thescopeofthegreatertrochanter,roughoutlineofglutealmusclecontracturebelt,andC‐shapedreleasepathweredelineated(Fig.1).??Fig.1Beforethesurgery,delineatethescopeofthegreatertrochanter(markedarchedfullline),roughoutlineofglutealmusclecontracturebelt,twoarthroscopicportals(marked+),andC‐shapedreleasepath:ITB5?cmnearlydistalofthegreatertrochanter,posteriorandsuperiorofthegreatertrochanter.?ApproachandExposureTwoarthroscopicportalswereused:anteriorandposteriorportals.Bothoftheseportalsareplacedat5–6?cmdistalofthegreatertrochanter(Fig.1).Thedistanceofthetwoportalsisabout5–7cm.Then,disinfectedanddraped,a5×?5?cmoperationzonewasseparatedabovethesurfaceofITBandglutealmusclecontracture.Salinewaslocallyinjectedtoformanoperationspaceunderarthroscopy,theninsertthearthroscope,fatandfibroustissueswereclearedbyashaverandelectrocauterydevice.??Fig.1Beforethesurgery,delineatethescopeofthegreatertrochanter(markedarchedfullline),roughoutlineofglutealmusclecontracturebelt,twoarthroscopicportals(marked+),andC-shapedreleasepath:ITB5cmnearlydistalofthegreatertrochanter,posteriorandsuperiorofthegreatertrochanter.??ArthroscopicReleaseThearthroscopicC‐shapedreleasewasformedbythreeparts:ITBtissueabout5?cmdistaltotheproximalendofthegreatertrochanter,contracturetissuenearlyposteriorofthegreatertrochanter,andcontracturetissuesuperiorofthegreatertrochanter(Fig.2).Toensuresatisfactorytreatmentoutcomesandlesssurgicaltrauma,whichpartswereactuallyreleasedwasdecidedaccordingtointraoperativephysicalexaminationandarthroscopicobservation.??Fig.2ThetargetareaofarthroscopicC‐shapedreleasewasformedbytheITBtissue5?cmdistaltotheproximalendofgreatertrochanter(A),thecontracturetissuenearlyposterior(B)andsuperior(C)ofthegreatertrochanter.??First,thefull‐thicknessITBwastransverselyreleasedatabout5?cmdistaltotheproximalendofgreatertrochanter(Fig.3A).Forpatientswithseverebursitis,theinflammatorytissuearoundthegreatertrochanterwasdebridedwitharadiofrequencybladeafterthecontracturewasreleased.Thentheintraoperativephysicalexaminationwasperformed,includingOber'ssign,passivemaximumflexion,adduction,internalrotationandabductionofthehip.Iftheexaminationswerenegative,theoperationprocedurewasfinished.??Fig.3(A)InthefirststepofC‐shapedrelease,ITBtissue5?cmnearlydistalofthegreatertrochanterwasrelease,whichwasoneofkeyproceduresintheoperation.Inmildpatients,Ober'spositivesignsandmainsymptomdisappearedafterthisrelease.(B)Afterthefirststep,iftheintraoperativephysicalexaminationswerestillpositive,thesecondreleasestepforcontracturetissuenearlyposteriorofthegreatertrochanterwasnecessary.(C)Afterthesecondstep,iftherewasstillexcessivetensionofmusclecontractureinintraoperativephysicalexaminations,thecontracturetissueatthesuperiorofthegreatertrochantershouldbereleasedinthethirdstep.??Iftheintraoperativephysicalexaminationswerestillpositive,thesecondreleasestepforcontracturetissueneartheposteriorofthegreatertrochanterwasnecessary(Fig.3B).Afterthat,iftherewasstillexcessivetensionofmusclecontractureinintraoperativephysicalexaminations,thecontracturetissueatthesuperiorofthegreatertrochanterwasreleasedinthethirdstep(Fig.3C).Afterthat,theintraoperativephysicalexaminationwasperformedagaintomakesureallthesymptomswerenegative.Next,thecontralaterallimbwasoperatedinthesameway.?TheConventionalGlutealMuscleContractureBandReleaseAnesthesiaandPositionInconventionalglutealmusclecontracturebandreleaseunderarthroscopy,lateralpositionandepiduralanesthesiawasusedastheC‐shapedrelease.Thescopeofthegreatertrochanterandroughoutlineofglutealmusclecontracturebeltweredelineated.?ApproachandExposureAfterdisinfectionanddraping,twoorthreearthroscopicportalsweremarkedneartheoutlineofglutealmusclecontracturebelt.A5×?5?cmoperationzonewascreatedabovethesurfaceofITBandglutealmusclecontracture,weintroducedamotorizedshavertodebrideandremovefattytissuetosearchfortheoutlineofcontracturebands.?ArthroscopicReleaseThenthecontracturebandswerefoundandreleaseduntilexcessivetensioninallthecontracturebandsdisappeared4.Finally,theintraoperativephysicalexaminationwasperformedtoensureenoughrelease,includingOber'ssign,passivemaximumflexion,adduction,internalrotationandabductionofhip.Thecontralaterallimbwasoperatedinthesameway.?PostoperativeTreatmentAftertheoperation,alternatinglateralpositionwasselectedforcompressionhemostasisandwounddrainageinbothtwogroups.Postoperativeanalgesiaandtreatmentforpreventingmyositisossificansweregiven.Functionalexercisewasconducted12?hafteroperationtopreventadhesion.Lowerextremityabductionexerciseswereemployedtostrengthengluteusmusclefrom1?dayto1?yearafteroperation.?OutcomeMeasuresTheaverageReleaseTimeInthestudy,theaveragereleasetimecalculatedfromaftermakingarthroscopicoperationspacetothelastreleaseofthecontracture.?GlutealMuscleContractureDisabilityScale(GDS)TheGDSscorecanbeusedtoevaluatethefunctionaldisabilityandrecoveryofthepatients.Allpatientswereevaluatedbeforesurgeryandatthelastfollow‐up.TheGDSscoreincludedgait,crossleg,squat,clickingsound,shapeofbuttocks,depressionoflocalskin,walkingupanddownthestairs,hiptired,painandfrictionofhip,painandfrictionofhip,closetogetherofknee,toucheachotherofanklesinsupineposition,restrictedrun,standinglongjumpandrestrictedhurdling.?VisualAnalogueScale(VAS)A10?cmhorizontallinewasdrawnonpaper,andequallydividedinto10sections.Oneendofthelinewasmarked0,indicatingtotallynopain;theotherendwas10,indicatingmostseverepain;themiddlesectionsindicateddifferentdegreesofpain.Eachpatientmarkedacertainsectiononthehorizontallineaccordingtothedegreeofpain.?WoundHematomaWoundhematomawasrelatedtosurgicalinjuryofmuscleandfattissue,whichwoulddelaytherecoverytime.Inthestudy,wedidnotusedrainageforallpatient,thisallowedpatientsearlyfunctionalexercise.?AbductorWeaknessExcessivereleaseofthemusclewouldresultinabductorweakness.Thenormalmuscletissueshouldbewoundedaslittleaspossibleduringtheoperation.IntheC‐shapedrelease,theareaaroundthegreatertrochanterhadlessmuscletissuetobereleasedthanthereleaseareaintheconventionaltechnique,whichmeantlesseffectonmusclestrength.?StatisticalMethodWeusedSPASS22.0software(IBM,Armonk,NY,USA)forstatisticalanalysis.Quantitativedataincludedage,theaveragereleasetime,GDSandVAS,whichweretestedbytheK‐Snormaldistributiontestandvariancehomogeneitytestshowednormaldistributionandneatvariance.At‐testwasusedtocomparetheage,theaveragereleasetime,theGDSandVASbeforeandaftersurgeryofthetwogroups.Countdataincludedgender,thenumberofwoundhematomaandabductorweaknessinthegroups.Comparisonsbetweencountswerecomparedbyachi‐squaretest.StatisticaldifferenceswereconsideredsignificantforPvalues?0.05).Atthelastfollow‐up,theGDSwere91.7±?5.2(range,84to100)intheC‐shapedreleasegroupand90.2±?6.1(range,83to98)intheconventionalreleasegroup,thedifferencewasnearlysignificant(P=?0.073)(table1).?VisualAnalogueScale(VAS)VASbeforesurgerywas3.5±?1.6(range,0to6)intheC‐shapedreleasegroupand3.6±?1.8(range,0to6)intheconventionalreleasegroup,withnostatisticallysignificantdifference(P>?0.05).Atthelastfollow‐up,theVASwas0.052±?0.22(range,0to1)intheC‐shapedreleasegroupand0.067±?0.25(range,0to1)intheconventionalreleasegroup(Table1).?ComplicationsTherewasnorevisionsurgery.IntheC‐shapedreleasegroup,onecasehadtemporarywoundhematomaafteroperation,andfivecasesintheconventionalreleasegroup,thestatisticaldifferencewasnearlysignificant(P=?0.079).Twocaseshadabductorweaknessofhipjoint(musclestrengthgradeIV)intheC‐shapedreleasegroup,andfivecasesintheconventionalreleasegroup(P=?0.208),duetoexcessiverelease,whohadnearnormalmusclestrengthbeforesurgery.Atthelastfollow‐up,musclestrengthofthesixcasesreturnedtonormal.Allpatientshadgoodwoundhealing(Table1).?DiscussionInthisstudy,weintroducedanarthroscopicC‐shapedreleasearoundgreatertrochanteringlutealmusclecontracture,whichhadoptimisticoutcomesonoperatingtime,symptomimprovement,complications,andGDSscoreaccordingtothiscomparativestudy.?BasicBackgroundGlutealmusclecontracturewasfirstreportedbyValderramain196911.Itwascharacterizedbycontractureofglutealmuscles,tensorfascialata,ITB,etal.12,13,14.Patientswerefoundallovertheworld,butmanymorewerereportedinChinawithachildhoodincidencerateof1%–2.5%1.Fortherefractorypatientswhodidnotresponsewelltothenonsurgicaltreatments,surgicalinterventionwasnecessary.Arthroscopyreleaseinglutealmusclecontracturewasfirstreportedbyourteam,andhadobtainedagoodsurgicaleffect4.ThenRaietal.andZhangetal.respectivelyintroducedtheadvantageofarthroscopicsurgerybycomparingthearthroscopicsurgeryandopensurgery8,15.?FeasibilityoftheReleaseMethodSomesurgeonsreportedseveralmethodsforreleasecontractureband.Raietal.reportedamethodwithFreleaseinITBandgluteusmaximuscontractures,andCreleaseindeeperstructures,whichhadacomplicatedprocedureandnoindividuationforeachpatient8.Zinietal.usedendoscopicITBreleaseinsnappinghip,howeverthisinvariantreleasewaymayleadtoinsufficientreleaseincomplexcases9.Othersurgeonsperformedsmallincisionsurgeryaroundthegreatertrochanterfollowingaspecialdesignedpathwaytoreleasecontracturebands16.Inthisstudy,weusedC‐shapedreleasearoundthegreattrochanterunderarthroscopyinordertoobtainbetteroutcomes.TheC‐shapedareaaroundthegreatertrochanter,wassurroundedbylessmuscletissuetobereleasedunderarthroscopy(Fig.2),whichtheoreticallymeantlesseffectonmusclestrength.Meanwhile,thisareadidnothaveknownnerveandvasculartissue,whichreducedtherateofneurovascularinjury.Ourteamdescribedvarioustypesofcontractureunderarthroscopyin20137,whichprovidedmorereferenceinformationforarthroscopicreleaseinglutealmusclecontracture.Differentfrommerelyreferringtopreoperativeevaluationinsomeofthepreviousstudies,thisstudycarefullyevaluatedtheintraoperativephysicalexaminationandarthroscopicobservationbesidepreoperativeevaluation,toavoidinsufficientreleaseandpoorclinicaloutcomes.Inthe‘C'shapereleasearoundthegreatertrochanter,weroutinelytransverselyreleasedtheITBatabout5?cmdistaltotheproximalendofthegreatertrochanteratfirst,whichwasoneofkeyproceduresintheoperation.Inmildpatients,Ober'spositivesignsandmainsymptomdisappearedafterthisrelease,whichwasmentionedinZinietal.'sreport9.Ifclickingsoundandexcessivemuscletensionofthehipexistedaftertheaboverelease,thesecondandthirdstepsshouldbeperformedcloselyaccordingtothearthroscopicobservation,longitudinalreleaseofthecontracturetissueneartheposteriorthegreatertrochanteroradditionalreleaseofthetissuenearthesuperiorofthegreatertrochanter.ThisC‐shapereleasewaslimitedtotheareaaroundthegreattrochanterwhichtheoreticallywaseasiertooperate.?SurgicalOutcomesAtthesametime,thearthroscopiccontracturereleasetimeaftermakingarthroscopicoperationspaceforeachlowerlimbinC‐shapedreleasewas12.2min±?3.2min,and21.4min±?6.1min(p

臀肌攣縮，是指兒童時(shí)期反復(fù)臀部肌肉注射藥物造成的肌筋膜和肌肉的疤痕組織增生。疤痕一般是青霉素融媒-苯甲醇刺激成纖維細(xì)胞異常增生造成的。以往是切開(kāi)松解，自從我在2001年發(fā)明關(guān)節(jié)鏡松解后，微創(chuàng)手術(shù)成為主流。關(guān)節(jié)鏡下脂肪、肌肉、肌腱、增生瘢痕清晰可辨。但由于切割疤痕通過(guò)等離子刀頭產(chǎn)生的熱量氣化組織，相隔一公分內(nèi)的神經(jīng)會(huì)受到刺激產(chǎn)生肌肉抽動(dòng)，甚至極少見(jiàn)的神經(jīng)損傷。手術(shù)路徑?jīng)]有粗大的血管，最常見(jiàn)的是圖中所見(jiàn)的小血管會(huì)被熱凝固，所以一般不會(huì)有大出血。

臀肌攣縮的三大特征：無(wú)法正常的翹二郎腿，無(wú)法走一字步，無(wú)法并腿下蹲。而通過(guò)關(guān)節(jié)鏡微創(chuàng)手術(shù)松解，再結(jié)合術(shù)后功能鍛煉，能恢復(fù)正常的翹二郎腿，正常的走一字步，以及正常的并腿下蹲。袁鋒主任門(mén)診時(shí)間：六院臨港院區(qū):周二下午特需門(mén)診2樓8號(hào)間周三上午專(zhuān)家門(mén)診2樓9號(hào)間六院徐匯院區(qū):國(guó)家骨科醫(yī)學(xué)中心8號(hào)樓周三下午特需門(mén)診3樓3號(hào)間周五全天專(zhuān)家門(mén)診2樓13號(hào)間

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