孙晟轩 葛州 董启榕 周海斌

[摘要] 目的 探討关节镜微创治疗成年人臀肌挛缩症的临床效果。 方法 回顾性分析2011年8月～2015年6月苏州大学附属第二医院收治的184例臀肌挛缩症患者的临床资料，根据手术方法不同分为观察组（95例），对照组（89例），观察组采用关节镜辅助下等离子刀松解，对照组采用常规切开松解。比较两组单侧手术时间、切口长度、术后下床时间及术后住院时间，比较末次随访时患者的臀肌挛缩松解术后功能与疗效评价。结果 观察组有91例获得完整随访资料，平均随访时间为（19.6±3.4）个月，对照组有87例获得完整随访资料，平均随访时间为（17.4±4.1）个月。观察组单侧松解手术时间、切口长度、术后下床时间、术后住院时间明显短于对照组，差异有统计学意义（P < 0.05）。末次随访时观察组术后功能与疗效评价优良率（92.3%）与对照组（94.3%）之间差异无统计学意义（P > 0.05）。 结论 关节镜辅助等离子刀松解挛缩带及腱板是治疗成年人臀肌挛缩症的首选方法，创伤小，恢复快，充分松解，术后早期康复锻炼，改善髋关节功能，缩短住院时间。

[关键词] 臀肌挛缩；微创；关节镜；射频

[中图分类号] R685.4 [文献标识码] A [文章编号] 1673-7210（2018）05（c）-0080-04

Arthroscopic radiofrequency lysis for treatment of gluteal muscle contracture

SUN Shengxuan GE Zhou DONG Qirong ZHOU Haibin

Department of Orthopedics， Second Affiliated Hospital of Soochow University， Jiangsu Province， Suzhou 215004， China

[Abstract] Objective To investigate the clinical effect of arthroscopic radiofrequency lysis in the treatment of gluteal muscle contracture. Methods From August 2011 to June 2015， in the Second Affiliated Hospital of Soochow University， the clinical data of 184 patients of gluteal muscle contracture associated with intramuscular injection were retrospectively analyzed， they were divided into the observation group （95 cases） and the control group （89 cases） according to the different operation methods. The observation group was treated with arthroscopic radiofrequency lysis and the control group was treated with conventional open surgery. The average operating time for one side， incision length， the time out of bed and post-operation length of stay were compared between two groups， and the difference of the evaluation of gluteal muscle contracture at the last follow-up was analyzed. Results Ninety-one patients in the observation group were obtained follow-up data with an average of （19.6±3.4） months， while 87 patients in the control group were obtained follow-up data with an average of （17.4±4.1） months. The average operating time for one side， incision length， the time out of bed and post-op length of stay in observation group was shorter than the control group， the differences were statistically significant （P < 0.05）. The good to excellent rate of gluteal muscle contracture in the last follow-up in the observation group （92.3%） and the control group （94.3%） were compared， the difference was not statistically significant （P > 0.05）. Conclusion Arthroscopic radiofrequency releasing the bands is the first choice for the treatment of gluteal muscle contracture associated with intramuscular injection， which can reduce tissue trauma， the length of incision， result in early time to rehabilitation for good joint function and shorten length of stay in the hospital.

[Key words] Gluteal muscle contracture； Minimally invasive； Arthroscopic； Radiofrequency

臀肌挛缩症是由多种因素引起的臀部肌肉及筋膜纤维变性、挛缩，进而导致髋关节内收、内旋等功能障碍，伴有特殊的步态及体征的临床综合征。国外学者Valderrama[1]于1970年首次报道该疾病，国内学者马承宣等[2]于1978年研究发现大部分患者是由于臀部反复注射由苯甲醇做溶媒的青霉素制剂所导致。多数青年患者由于“外八字”的步态及身体形态的异常导致生理及心理障碍，而选择积极手术治疗[3]。……