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目的探讨儿童臀肌挛缩致骨盆倾斜的发生机制、手术方法和治疗效果。方法对36例臀肌挛缩致骨盆倾斜患儿术前检查均发现有双下肢不等长,假性长肢侧髋关节内收明显受限,骨盆前后位X线片示骨盆倾斜角5°~28°,平均15.5°;术中除松解挛缩的臀大肌及其筋膜外,探查发现髋关节外展肌明显挛缩,予以彻底松解。结果36例臀肌挛缩致骨盆倾斜患儿术中发现除假性长肢侧髂胫束、臀大肌筋膜及前外侧肌纤维纤维化挛缩外,髋关节外展肌明显挛缩,其中仅臀中肌挛缩者5例(13.9%),仅臀小肌挛缩者21例(58.3%),臀中、小肌均有挛缩者10例(27.8%)。手术松解挛缩的臀中肌和/或臀小肌以及髂胫束、臀大肌筋膜及前外侧肌纤维,恢复假性长肢侧髋关节内收功能和双下肢等长。随访32例,平均随访3.5年。27例完全矫正;5例髋关节内收轻度受限,其中3例仍有轻度骨盆倾斜,患肢长0.5~1.5cm。无一例出现髋关节外展肌力减弱。骨盆前后位X线片显示29例术后骨盆倾斜完全消失,3例骨盆倾斜角残留5°~10°。结论儿童髋关节外展肌挛缩是臀肌挛缩导致骨盆倾斜的主要原因,尤以臀小肌挛缩发生率高,且位置隐蔽。对臀肌挛缩伴有骨盆倾斜者,手术中应注意探查髋关节外展肌,对挛缩明显的予以彻底松解。
Objective To investigate the mechanism, operation method and therapeutic effect of pelvic tilt caused by gluteal muscle contracture in children. Methods 36 cases of gluteal muscle contracture-induced pelvic tilt in children with preoperative examination found that both lower extremities unequal length, pseudo-long limb hip adduction was significantly limited, the pelvis anteroposterior X-ray showed pelvic tilt angle 5 ° ~ 28 °, an average of 15.5 °; operation in addition to the release of contracture of the gluteus maximus and fascia, the probe found significant contracture hip abductor muscle, to be completely loosen. Results 36 cases of gluteal muscle contracture induced pelvic tilt in children found in addition to false long limb side of the iliotibial band, gluteus maximus fascia and anterolateral myofibrosis contracture, the hip abductor muscle obvious contracture, of which only the buttocks There were 5 cases of muscle contracture (13.9%), 21 cases (58.3%) of only gluteus minimus contracture and 10 cases (27.8%) of contracture of gluteus medius and small muscle. The operation releases the gluteus medius and / or the gluteus medius muscle and the iliotibial band, the gluteus maximus fascia and the anterolateral muscle fiber of the contracture and restores the adducting function of the hip and the lower extremities of the pseudo-long limb. Follow-up 32 cases, with an average follow-up of 3.5 years. 27 cases were completely corrected; 5 cases of hip adduction limited mild, of which 3 cases still mild pelvic tilt, limb length 0.5 ~ 1.5cm. None of the cases of hip abduction muscle weakness. The pelvis anteroposterior X-ray showed 29 cases of postoperative pelvic tilt completely disappeared, 3 cases of pelvic tilt angle 5 ° ~ 10 °. Conclusions Abduction of hip joint abductor muscles in children is the main reason of gluteus contracture leading to pelvic tilt, especially the incidence of hip gluteal muscle contracture is high and the position is hidden. On the gluteal muscle contracture associated with pelvic obliques, surgery should pay attention to explore the hip abductor muscles, the contracture was completely loosen.