Scully William F, White Klane K, Song Kit M, Mosca Vincent S
*Orthopaedics Service, Martin Army Community Hospital, Fort Benning, GA †Seattle Children's Hospital, Seattle, WA ‡Shriners Hospitals for Children, Los Angeles, CA.
J Pediatr Orthop. 2015 Mar;35(2):192-8. doi: 10.1097/BPO.0000000000000238.
Adoption rates are increasing in the United States and other developed countries. A large proportion of adopted children have been found to have unsuspected medical diagnoses, including orthopedic problems. One condition, termed injection-induced gluteus maximus contracture, has been previously described in several case series and can be difficult to diagnose if unfamiliar with this condition. By reviewing the etiology and pathoanatomy of this problem, as well as the typical examination findings, including the near-pathognomonic-positive "reverse Ober test," treating providers will be better prepared to recognize and properly treat this condition.
This is a retrospective review of 4 patients treated at our institution for injection-induced gluteus maximus contracture. Patient history, physical examination findings, and treatment outcomes were recorded. All had undergone surgical treatment through a longitudinal incision along the posterior margin of the iliotibial band, with division of thickened, contracted gluteus tissue down to the ischial tuberosity.
All 4 of the patients were adopted from orphanages in developing countries. Chief complaints of the patients varied, but physical examination findings were very consistent. Three of the 4 patients had undergone rotational osteotomies for presumed femoral retroversion before their diagnosis and treatment for injection-induced gluteus maximus contracture. All patients had concave, atrophic buttock contours and numerous punctate buttock scars. All walked with an out-toed gait and had marked apparent femoral retroversion. Each patient was found to have full hip adduction when the hip was extended but a hip abduction contracture when the hip was flexed. This finding of increasing abduction as an extended/adducted hip is flexed to 90 degrees is described as a positive "reverse Ober test." After surgical treatment, all hips could adduct to neutral from full extension to full flexion.
Although common in some countries, such as Russia and China, injection-induced gluteus muscle contractures are seldom seen in the United States and other developed countries. Diagnosis of this condition can be difficult leading to inappropriate treatment. Knowledge of the clinical presentation typical of a gluteus contracture and of the pathognomonic finding of a "reverse Ober test" can facilitate an effective surgical procedure to correct the associated functional impairment.
Level IV: retrospective case series.
在美国和其他发达国家，收养率正在上升。已发现很大一部分被收养儿童患有未被怀疑的医学病症，包括骨科问题。有一种病症，称为注射性臀大肌挛缩，此前已在多个病例系列中有所描述，如果不熟悉这种病症，可能难以诊断。通过回顾该问题的病因和病理解剖，以及典型的检查结果，包括近乎具有诊断意义的阳性“反向奥伯试验”，治疗人员将能更好地准备识别并妥善治疗这种病症。
这是一项对在我们机构接受治疗的4例注射性臀大肌挛缩患者的回顾性研究。记录了患者病史、体格检查结果和治疗结果。所有患者均通过沿髂胫束后缘的纵向切口接受了手术治疗，将增厚、挛缩的臀肌组织一直分离至坐骨结节。
所有4例患者均从发展中国家的孤儿院收养。患者的主要症状各不相同，但体格检查结果非常一致。4例患者中有3例在诊断和治疗注射性臀大肌挛缩之前因疑似股骨前倾接受了旋转截骨术。所有患者臀部轮廓凹陷、萎缩，并有多处点状臀部瘢痕。所有患者行走时呈外八字步态，并有明显的股骨前倾。发现每个患者在髋关节伸展时髋关节可完全内收，但在髋关节屈曲时存在髋关节外展挛缩。当伸展/内收的髋关节屈曲至90度时外展增加的这一发现被描述为阳性“反向奥伯试验”。手术治疗后，所有髋关节从完全伸展到完全屈曲均可内收到中立位。
虽然注射性臀肌挛缩在俄罗斯和中国等一些国家很常见，但在美国和其他发达国家很少见。这种病症的诊断可能很困难，导致治疗不当。了解臀肌挛缩的典型临床表现和“反向奥伯试验”的诊断性发现有助于实施有效的手术程序来纠正相关的功能障碍。
IV级：回顾性病例系列。
