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目的探讨关节镜监视下射频汽化技术治疗儿童臀肌挛缩症的临床效果及有关适应证。方法2005年1月～2006年5月,采用关节镜监视下射频汽化治疗儿童臀肌挛缩症58例,男33例,女25例;年龄6～13岁,平均9岁。侧卧位,术前标记坐骨神经走行,股骨大转子,臀肌挛缩带和手术入口,于大转子区顶点后方2 cm切开5 mm,骨膜剥离器插入皮下筋膜组织与臀肌挛缩带之间,钝性分离5 cm×5 cm的工作腔隙,生理盐水充盈后在关节镜监视下,汽化电极斜行切断并松解挛缩组织,直至无活动性出血,阳性体征消失。结果术后随访3～12个月,按照有关臀肌挛缩症的疗效标准进行综合评定,优45例,良9例,中3例,差1例。伤口Ⅰ期愈合,无血管神经损伤等严重并发症。结论关节镜监视下射频汽化治疗儿童轻中度臀肌挛缩症,操作安全,疗效满意,创伤小,外形美观,痛苦少,有利于早期功能锻炼和康复。
Objective To investigate the clinical effect of radiofrequency vaporization under arthroscopy in children with gluteal muscle contracture and its indications. Methods From January 2005 to May 2006, 58 children with gluteal muscle contracture were treated by arthroscopic radiofrequency vaporization, including 33 males and 25 females. The average age was 9 years (range 6 to 13 years). Lateral position, preoperative sciatic nerve walking, greater trochanter, gluteal muscle contracture and surgical entrance, in the greater trochanter apex posterior 2 cm incision 5 mm, periosteal dissector inserted between the subcutaneous fascia and gluteal muscle contracture zone , Blunt dissection of 5 cm × 5 cm of the working space, the physiological saline filling in the arthroscopic monitoring, vaporization electrode oblique line cut off and release of contracture tissue until no active bleeding, the positive signs disappear. Results The patients were followed up for 3 to 12 months. According to the standard of curative effect on gluteal muscle contracture, 45 were excellent, 9 were good, 3 were fair, and 1 was poor. Wound healing, no vascular nerve injury and other serious complications. Conclusion Under the arthroscopy, radiofrequency vaporization treatment of children with mild to moderate gluteal muscle contracture, safe operation, satisfactory results, less trauma, beautiful appearance, less pain, is conducive to early functional exercise and rehabilitation.