gluteal muscle contracture
Introduction
Introduction to gluteal muscle contracture Gluteal muscle contraction (GMC) is a clinical syndrome characterized by a variety of causes, such as gluteal muscle and fascial fibrosis, contracture, and unique gait and signs that cause hip function limitation. Since the 1970 Valderrama1 report, there have been many reports at home and abroad, but the etiology and classification are not very clear. This article reports 101 cases of various types of GMC admitted to our hospital from September 1982 to June 1997, with a focus on its etiology, type and treatment issues. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: trigeminal neuralgia
Cause
Causes of gluteal muscle contracture
The cause of gluteal muscle contracture is not completely clear at present, and it is thought to be related to repeated intramuscular injection of the buttocks. Most of the cases reported in the literature are caused by injection, and there is no exact classification method for gluteal muscle contracture. We believe that gluteal muscle contracture is a group of clinical syndromes characterized by hip dysfunction. Classification according to the etiology and degree of disease helps to better understand and guide the treatment of gluteal muscle contracture.
Benzyl alcohol as penicillin-soluble (30%):
Injectable gluteal muscle contracture has been reported in a large number of literatures at home and abroad, and is more common in countries and regions where there are habits of hip muscle injection. Domestic regional surveys show that the prevalence of children is 1% to 2.49%, and it is pointed out that benzyl alcohol is the most dangerous pathogenic factor for penicillin. This group of patients showed that the younger the age of onset of intramuscular injection, the higher the incidence rate (average age of onset is 2.7 years), indicating that the immune function and anatomical characteristics of infants and young children are directly related to the occurrence of gluteal muscle contracture. Particularly noteworthy is that in this group of 6 patients (8.5%) with sciatic nerve injury, 5 patients were missed gluteal muscle contracture, and 1 patient was misdiagnosed as "baby sputum" for a long time, suggesting a close relationship between the two. Nerve release and contracture band release should be performed as early as possible and early. We understand that most patients with injection gluteal muscle contracture can achieve good results by partial resection of the contracture band. In most cases, it is not necessary to expose the sciatic nerve, but the lesions are extensive, especially in the small external rotator muscle group or hip capsule sac contracture. In order to prevent damage to the nerve, the sciatic nerve should be exposed first. Patients with gluteal muscle contracture and difficulty in loosening surgery may be treated with a sacral incision and a tibia detachment. The advantage is that it can not only achieve good surgical results, but also prevent the accidental injury of the sciatic nerve and the contracture band after extensive release of the hip joint weakness.
Surgery (30%):
The gluteal muscle contracture after congenital dislocation of the hip occurred mostly in children with older age, high femoral head dislocation, open reduction, and pelvic osteotomy, with an incidence of 0.4%. Due to the wide range of operation, heavy tissue damage, and prone to fibrosis, the high dislocation of the femoral head is restored to the primary acetabulum and the pelvic osteotomy rotates and prolongs. The periosteal membrane is sutured under tension to make the gluteal muscle relatively prolonged and the muscle tension is significantly increased; In addition, long-term gypsum brakes in the post-operative booth may aggravate muscle tone and ischemic state and cause fibrosis. Secondly, the tightness of the hip joint capsule can also cause abduction contracture deformity. Some authors believe that some patients have a slight neglect of preoperative gluteal muscle contracture symptoms, and the symptoms of pelvic prolongation are obvious. The preventive measures include adequate traction before surgery, and the hip joint capsule should not be over-sewn during the operation. If the tension is too high when the periosteum is sutured, it may not be sutured in situ. Because the formation of such gluteal muscle contracture is mainly related to postoperative gluteal muscle hypertonia and fibrous scarring, we understand that sputum incision and gluteal muscle origination down surgery are more suitable for this type of patient.
Long-term compression of the buttocks (30%):
The gluteal compartment syndrome is rare, mostly unilateral. The main cause is the long-term compression or trauma of the buttocks caused by the loss of consciousness after the loss of consciousness. The former is often neglected due to the existence of systemic complications and delays diagnosis; the latter can not cause this because of the severe pain associated with timely decompression. complication. The pathological mechanism is the same as that of the four limbs fascia compartment syndrome, which eventually causes the ischemic necrosis and contracture of the indoor gluteal muscle. However, since the sciatic nerve does not directly pass through the gluteal fascia, there are no symptoms or symptoms of nerve damage. Timely cutting and decompressing to save vitality of the remaining muscle tissue can prevent the occurrence of gluteal muscle contracture. After the operation, the hip will be placed in the internal flexion and hip and early functional exercise. Symptoms of gluteal muscle contracture should be removed by elective surgery.
Prevention
Gluteal muscle contracture prevention
1. The key to preventing gluteal muscle contracture in children is that young parents should attach great importance to this disease. Minimize or avoid injecting highly toxic and irritating drugs into the buttocks muscles, especially those that should not be diluted with benzyl alcohol.
2, the injection method and location should be correct, the dose should be reasonable, the injection speed should be slow, try to avoid continuous injection of the same part. Local hot compress and physiotherapy should be carried out after injection to facilitate the absorption of the drug solution and improve local blood circulation.
Complication
Gluteal muscle contracture complications Complications trigeminal neuralgia
Muscle necrosis, trigeminal neurotrophic damage.
Symptom
Symptoms of gluteal muscle contracture Common symptoms of sputum difficulty muscle atrophy gluteal sulcus drooping gait gait gluteus medullary muscles gluteal muscle contraction gluteal groove flat and drooping gluteal groove seems to be sandwiched... hip lightning pain hip muscle paralysis gait Octopus gait
The child initially felt embarrassed, ran, jumped, and walked on the road. If further examination can be found, the hip flexion, adduction, and internal rotation of the child are limited, the lower limbs can not be completely close together, mild external rotation, the lower hips are abducted and externally rotated, the knees can not be close together, showing a frog Position. Most of the children's buttocks do not look as full as normal buttocks. Local muscle atrophy, skin sag, sometimes orange peel, can touch the cord-like sac.
Examine
Examination of gluteal muscle contracture
Length of the lower limbs, waist-to-hip ratio, quadriceps muscle strength test, bone and joint flats of the extremities, electromyography.
X-ray performance was reported as normal. Fang Xueguang and Han Jingming's X-ray study of children with contracture found an increase in CE angle (X=36?62), an increase in neck angle (X=153), and a decrease in femoral head index (X=0?44). Early surgery at postoperative follow-up contributes to the recovery of the above secondary changes. Liu Ruilin's CT scan of patients with gluteal muscle contracture showed that the early inflammatory lesions showed a reduced density zone. In the late stage, the muscle fibers were replaced by connective tissue, and the muscle fibers were reduced in density and increased in density. The gap between the membranes is widened, and when the scar is finally formed, it appears as a shadow. Scanning provides valuable clinical data on the location, extent and severity of the lesion.
Diagnosis
Diagnosis and differentiation of gluteal muscle contracture
The disease is often bilateral, rare on one side, and there are reports of more men than women.
Hip dysfunction
The patient's hip internal rotation is limited. When standing, the external extremity is rotated, and it cannot be completely close. Walking often has an outer eight, a swinging gait, and a quick step is jumping. When you sit down, your legs can't be close together. The hips are separated by a frog-like position, and one side of the thigh is difficult to rest on the other side of the thigh (cross-leg test). When the squatting activity is light, the knees are separated first, then the squatting is followed by the squatting. The severe one can only kneel in the abduction and external rotation position. When the armpit is under the abduction, the hip joints are abducted and externally rotated. The knees cannot be close together, and the heel does not touch the ground. Physical examination revealed skin depression on the upper part of the buttocks. The depression was more obvious when the hip was adducted. The buttocks could be tightened. The lower extremities showed abduction and external rotation. The hips were restricted and the internal rotation was limited. The lower limbs had limited hip flexion activity. It is necessary to have hip abduction and external rotation, so that the affected side of the hip is half-circular outward to return to the original sagittal plane and fully flex. Femoral trochanter bounce. The Ober sign is positive.
Pelvic variant
In severe cases, the acetabular sulcus protrudes into the pelvis and forms the Otto's pelvis. Children with gluteal small muscle contracture have large trochanter bone hypertrophy. Children with bilateral asymmetrical gluteal muscle contracture may have pelvic tilt and secondary lumbar scoliosis. The severe lateral anterior superior iliac spine is lower on the lighter side, the heavy side umbilical hernia is longer than the light side, and the distance from the greater trochanter to the ankle is equal.
