Ni Bing, Li Ming
Department of Orthopaedics, Affiliated Hospital of Children of Chongqing University of Medical Science, Chongqing 400016, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2007 Jul;38(4):657-9, 677.
To explore the effect of children's gluteal muscle contracture (GMC) on skeleton development.
The pelvic plain films of 368 GMC cases confirmed by operation from May 1995 to June 2005 and those of 200 individuals as control were analyzed for this research project. The pelvic CT scans were performed in 30 GMC cases and 25 controls. The data of both groups were used to comparison, analysis and statistics treatment in pelvic plain X-ray film, hip joint, acetabular index, neck shaft angle, centre-edge (CE) angle, the form of pelvic obturator foramen, the existence or nonexistence of the iliac hyperdense line.
There were 68 cases with pelvis obliquity in the case group but no one in the control group. The iliac hyperdense lines at the side of sacroiliac joints were found on the pelvic plain films of 321 of 368 cases with GMC and 5 of 200 controls. In 368 cases with GMC, the iliac hyperdense lines were detected in 306 of 314 patients beyond 7-year-old, and 313 of 336 appeared mostly the contracture of gluteus maximus muscle, which showed to be significant in statistics. In GMC group, the oblique plane became steeper and almost oriented posteroanteriorly, while in control group,the pelvic CT showed that the outer codex of posterior ilium at the level of sacroiliac joint appeared as an oblique plane, oriented from posteromedial to anterolateral side. The data were processed with statistics software, found that compared with the control group, the results of pre-operation group's examines such as CE angle, neck shaft angle, longitudinal diameter, cross diameter, and the iliac hyperdense line had significant differences (P < 0.01), the results of post-operation group's those examines showed no significant differences (P > 0.01), and the acetabular index appeared no significant differences (P > 0.01).
The children's gluteal muscle contracture has the significant effect on skeleton development, which could lead to pelvis obliquity, coxa valga, leg length pseudoinequality, CE angle increasing, etc. The iliac hyperdense line on the pelvic plain film is probably a characteristic change of GMC.
探讨儿童臀肌挛缩(GMC)对骨骼发育的影响。
本研究项目分析了1995年5月至2005年6月手术确诊的368例GMC患儿及200例对照者的骨盆平片。对30例GMC患儿和25例对照者进行了骨盆CT扫描。两组数据用于骨盆平片、髋关节、髋臼指数、颈干角、中心边缘(CE)角、骨盆闭孔形态、髂骨致密线有无等方面的比较、分析及统计学处理。
病例组有68例骨盆倾斜,对照组无1例。368例GMC患儿中321例骨盆平片显示骶髂关节侧有髂骨致密线,200例对照者中有5例。368例GMC患儿中,7岁以上314例患者中有306例检出髂骨致密线,336例中有313例主要表现为臀大肌挛缩,差异有统计学意义。GMC组斜平面变陡且几乎呈前后位,而对照组骨盆CT显示骶髂关节水平后髂骨外侧皮质呈一斜平面,从后内侧向外侧前。数据用统计学软件处理,发现与对照组相比,术前组CE角、颈干角、纵径、横径及髂骨致密线等检查结果差异有统计学意义(P<0.01),术后组这些检查结果差异无统计学意义(P>0.01),髋臼指数差异无统计学意义(P>0.01)。
儿童臀肌挛缩对骨骼发育有显著影响,可导致骨盆倾斜、髋外翻、腿长假性不等、CE角增大等。骨盆平片上的髂骨致密线可能是GMC的特征性改变。