22-year-old female college student Xiao Liu is young, beautiful, and has excellent academic performance. She is the "child of other people's family" in the eyes of parents. But Liu has his own troubles: from childhood to adulthood, he always felt that his walking posture was "weird", he could not squat normally, and he did not dare to wear beautiful groups in summer. He was often called "little frog" when he was a child. When I was learning to drive and take the driver's license test, Liu found that his feet could not step on the brakes and clutches normally, which added a little more trouble. She searched online for any similar situations to her, and found that she had a disease called " gluteal contracture " and had to be treated. So Liu found Professor Cheng Biao, director of the joint surgery department of Tongji Hospital Affiliated to Tongji University.
Professor Cheng Biao introduced that gluteal muscle contracture is a multi-factor degeneration, necrosis, and fibrosis of gluteal muscle and its fascial tissue caused by multiple factors, which can cause gluteal muscle, tensile fascia lata, iliotibial band and related fascial contractures. In severe cases, it involves the external rotation muscle of the hip joint, which is secondary to hip abduction, external rotation deformity, and adduction and internal rotation dysfunction, which is manifested as clinical symptoms of abnormal gait, posture and body shape.
At present, it is generally believed that gluteus muscle contracture is mostly induced by repeated intramuscular injection of penicillin injection diluted with benzyl alcohol in the buttocks. Because the patient has a scar constitution or lacks a certain immune factor in the body, normal muscle tissue gradually fibrosis and form a fibrous contracture band. Early lesions are limited to soft tissues such as the buttocks, glutes, , fascia, , etc. Since the skeleton development of young children has not been completed at this time, the contracture belt changes the balance of muscle strength attached to the pelvis and the upper end of the femur. The muscle tissue that has been fibrously degenerative with the pelvis and femur develops asymmetrically. The pelvis and femur develop rapidly, and the fibrotic gluteus muscle development is relatively lagging. If it is not treated early, it can gradually cause secondary changes in the pelvis and joints over time.
clinical manifestations and classification
Currently, in clinical practice, it is mostly divided into two types and three degrees according to the degree of lesion and clinical manifestations, namely typical types and special types, mild, moderate and severe.
Typical types: with an external eight-character gait, a cable-like object on the buttocks, a squat test with both knees together (+), unable to cross the legs, Ober sign (+), introversion of both lower limbs, internal rotation disorders, etc.
Special type: In addition to the clinical manifestations of the above typical types, it is also necessary to have pelvic tilt, causing pseudo-ine length of both lower limbs. When standing and walking, one lower limb is obviously abducted and extracircular. The pace is smaller when running, like jumping forward.
mild (or Ⅰ degree): Cross your legs with your legs crossed, but they are obviously limited, and may be accompanied by hip bounce and limb length. The surgical relaxation combined with series of functional exercises has the effect and is very ideal and has quick recovery.
Moderate (or II): Crossing your legs can only reach the tibial tuberculosis, but it does not yet combine the limbs and limbs are not equal in length. During the operation, the contracture tissue must be completely loosened, and functional exercises are required after the operation. The effect is still very ideal and the recovery is slow.
Heavy (or III): Cross your legs with your legs crossed only to the ankle, and the knees cannot be put together, and it is extremely externally rotated and abducted frog position. The pelvic tilt causes the limb to be pseudo-inconsistent, the internal rotation of both lower limbs is extremely limited, and even the cervical trunk angle and anterior inclination angle are increased and changed.
Treatment and rehabilitation
Most domestic and foreign scholars believe that once the muscle contracture is diagnosed, if there is no contraindication for surgery, it is necessary to treat surgically as soon as possible to avoid secondary pelvic tilt deformation, hip joint disease, etc. Commonly used traditional surgical methods include: contracture tissue resection, gluteus tendon Z-shaped extension, fascia lata aponeurosis metastasis, tissue contraction severity, gluteus starting point downward movement, gluteus end point upward movement, etc. Although traditional open surgery has a broad field of vision and is easy to completely loosen contracture tissue, the patient has a huge trauma. At the same time, because most of these patients have scar constitutions, the risk of contracture after surgery is high, and the wound is large, so the patient's acceptance is poor.
In recent years, with the development of sports medicine, arthroscopic technology has become the mainstream method of gluteal contracture relaxation.Microscopic relaxation treats gluteus contracture. Compared with traditional open surgery, the patient has a small incision, a small amount of bleeding, mild pain after surgery, early movement after surgery, short hospitalization time, and small scars and , after surgery, relatively beautiful, and is sought after by sports medicine doctors and gluteus contracture patients.
Postoperative functional exercise and physical therapy
1, postoperative functional exercise, flexion, introspect joints
2, step down the ground and walk straight
3, practice and knee squat
4, cross legs cross position
, Director Cheng Biao gave a bilateral gluteal muscle relaxation day after the arthroscopic bilateral gluteal muscle relaxation, and Liu could complete the above functional exercises, and the effect was very satisfactory. Liu was excited and shouted, "I can learn to learn a driver's license." The amplitude and intensity of functional exercise should be adjusted in time according to the specific situation of the patient and progress step by step. During the treatment process, ice-compression can relieve pain and edema; physical methods can also be used for treatment, such as ultrashort wave , ultrasonic and other treatments for buttock wounds and surrounding tissues on the second day after the operation. These physical factor therapies have the effects of promoting blood circulation and removing blood stasis, eliminating wound redness and swelling, promoting blood clot absorption, and improving tissue blood oxygen supply. They can also reduce patients' pain, improve body resistance, promote recovery of motor functions, reduce surgical scar formation, and prevent recurrence.
\ Expert name /
Cheng Biao
Chief physician of arthritis
Professor, PhD
Postdoctoral graduate supervisor
Expert clinic: Monday and Tuesday morning
Special clinic: Thursday morning
Director of arthritis surgery at Tongji Hospital Affiliated to Tongji University. Deputy Chairman of the Sports Medicine Branch of Shanghai Medical Association, Member of the National Orthopedic Arthroscopy Group, Founding Member of the China Shoulder and Elbow Surgery Cooperation Group, Member of the Upper Limb Surgery Group of the Sports Medicine Branch of the Chinese Medical Association, Deputy Head of the Arthroscopy Group of the Arthroscopy Group of Shanghai Medical Association, Member of the Hand Surgery Specialist Committee of Shanghai Sports Medicine Association, Director of the Shanghai Sports Medicine Association, Editorial Committee of the Chinese Journal of Orthopedic Surgery, Editorial Committee of the Chinese Version of Artroscopy, and Member of the Shanghai Medical Accident Expert Appraisal Committee.
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Pictures and texts | Joint surgery
Editing | Zhao Sisi Wang Beimo
proofreading | Xie Zhuangli
