Liu Yu-Jie, Xue Jing, Zhou Mi, Wang Zhi-Gang, Li Zhong-Li, Cai Xu, Wei Min, Wang Yan, Zhu Juan-Li
Department of Orthopedic Surgery, General Hospital of People's Liberation Army, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2008 Jul 1;46(13):970-2.
To evaluate the result of releasing adult intramuscular injection associated gluteal muscle contracture under the monitor of arthroscope by radiofrequency probe.
From June 2001 to June 2005, 108 cases of bilateral gluteal muscle contracture were treated with radiofrequency colation under the arthroscope and solution with an average age of 24 years (from 18 to 40 years). There were 57 males and 51 females. Preoperatively, the course of the outline of the femur greater trochanter the sciatic nerve in buttocks and the area of gluteal muscle contracture were marked. With the patients firmly anchored in the straight lateral position, normal saline (which contains Adnephrin) was injected between the surface of contracted gluteus and subcutaneous fat to reduce bleeding in operation. The ports for the motorized shaver and radiofrequency probe were located at the edge of gluteal muscle contracture and were 5 mm superior to the greater trochanter. The 6 mm diameter port for the arthroscope was 3 cm inferior to the greater trochanter. Space was made between contracture bands and overlying subcutaneous tissue with a periosteal elevator by blunt dissection. After the anterior and posterior edge of the contracture bands were fully revealed, normal saline were filled in the space. With the monitor of arthroscope, the procedures were: removing fatty tissue from the surface of the contracture bands with motorized shaver, then cutting off the contracture bands curve and carefully probing and cutting off contracture bands which were mixed in gluteus maximus with radiofrequency probe, finally hemostasis by radiofrequency probe. In the operation flexion, adduction, internal rotation and straightening hip joint were repeated, until it got normal range of motion without snap and bleeding. Results One hundred and one patients were followed up with an average of 19 months. According to a comprehensive evaluating system, 91 cases were excellent, 7 were good, and 3 were fair. No infection, recurrence and neurovascular injury occurred.
Gluteal muscle contracture could be effectively released with radiofrequency vaporization and solution. The technique has the advantage of easy to manipulate, minimally invasive, painless, safety and reliable curative effect, and is good for early functional exercises.
评估在关节镜监测下使用射频探头松解成人臀部肌肉注射所致臀肌挛缩的效果。
2001年6月至2005年6月，对108例双侧臀肌挛缩患者采用关节镜下射频松解及松解术治疗，平均年龄24岁（18至40岁）。男57例，女51例。术前标记股骨大转子轮廓、臀部坐骨神经走行及臀肌挛缩范围。患者取侧卧位固定，在挛缩臀肌表面与皮下脂肪间注射含肾上腺素的生理盐水以减少术中出血。电动刨削器和射频探头穿刺点位于臀肌挛缩边缘且在大转子上方5mm处，关节镜6mm直径穿刺点位于大转子下方3cm处。用骨膜剥离子钝性分离挛缩带与皮下组织间的间隙。挛缩带前后缘充分显露后，间隙内注入生理盐水。在关节镜监测下，先用电动刨削器清除挛缩带表面脂肪组织，再弧形切断挛缩带，然后用射频探头仔细探查并切断混入臀大肌内的挛缩带，最后用射频探头止血。术中反复屈伸、内收、内旋及伸直髋关节，直至活动范围正常且无弹响、无出血。结果101例患者获随访，平均随访19个月。根据综合评价系统，优91例，良7例，可3例。无感染、复发及神经血管损伤发生。
射频汽化及松解术可有效松解臀肌挛缩。该技术操作简便、微创、无痛、安全、疗效可靠，利于早期功能锻炼。
