关节镜下松解术治疗臀肌挛缩症
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摘要
[目的]探讨关节镜下松解术治疗臀肌挛缩症患者的临床效果。[方法]回顾分析2014年6月～2017年6月本院手术治疗的臀肌挛缩症患者129例。其中,镜下组65例,予以关节镜辅助下等离子刀切除挛缩带及腱板松解术;开放组64例,予以传统开放松解术。比较两组切口长度、术中出血量、手术用时、住院时间、下床活动时间和术后止痛药物使用人数比例及并发症发生情况。采用生活质量评分(SF-36)评价临床效果。[结果]镜下组切口长度短于开放组,镜下组术中出血量少于开放组,差异有统计学意义(P<0.05)。镜下组住院时间少于开放组,而下床活动时间早于开放组,差异有统计学意义(P<0.05)。镜下组术后止痛药物使用人数比例显著低于开放组(P<0.05);镜下组术后并发症发生率为3.08%,而开放组为14.06%,差异有统计学意义(P<0.05)。随访1年以上,两组术后1年SF-36评分均较术前增高(P<0.05),两组术后1年SF-36评分组间比较,差异无统计学意义(P>0.05)。镜下组术后1年功能和疗效优良率92.31%,与开放组95.31%相比,差异无统计学意义(P>0.05)。[结论]臀肌挛缩症患者予以关节镜下松解术治疗不仅疗效确切,且具有创伤轻、并发症少、患者疼痛感轻、术后恢复快等特点。
[Objective] To explore the clinical effect of arthroscopic release in the treatment of gluteal muscle contracture.[Methods] A retrospective study was conducted on a total of 129 patients who underwent surgical treatment for gluteal muscle contracture in our hospital from June 2014 to June 2017. Of them, 65 patients received arthroscopic release, while the remaining64 patients underwent open release. The incision length, intraoperative blood loss, operation time, hospital stay, ambulation time, analgesic used postoperatively and complications were compared between the two groups. The Short Form Health Survey(SF-36) was used for evaluation of the clinical outcomes. [Results] The arthroscopic group had significantly shorter incision length, significantly less intraoperative blood loss, significantly shorter hospital stay, and significantly earlier ambulation postoperatively than the open group(P<0.05). In addition, the proportion of analgesic used postoperatively in the arthroscopic group was significantly lower than the open group(P<0.05). The total early complication rate proved 3.08% in the arthroscopic group,while 14.06% in the open group, which was statistically significant(P<0.05). The follow-up period lasted for more than 1 year.The SF-36 scores significantly increased at 1 year postoperatively in both group compared with those before operation(P<0.05), despite of no statistically significant differences at any corresponding time point between the two groups(P>0.05). At 1 year postoperatively, the excellent and good rate of clinical outcomes proved 92.31% in the arthroscopic group, whereas 95.31%in the open group, which was not statistically significant(P>0.05). [Conclusion] Gluteal muscle contracture patients treated by arthroscopic release is not only effective, but also has the characteristics of less trauma, fewer complications, less pain and quick recovery.
[Objective] To explore the clinical effect of arthroscopic release in the treatment of gluteal muscle contracture.[Methods] A retrospective study was conducted on a total of 129 patients who underwent surgical treatment for gluteal muscle contracture in our hospital from June 2014 to June 2017. Of them, 65 patients received arthroscopic release, while the remaining64 patients underwent open release. The incision length, intraoperative blood loss, operation time, hospital stay, ambulation time, analgesic used postoperatively and complications were compared between the two groups. The Short Form Health Survey(SF-36) was used for evaluation of the clinical outcomes. [Results] The arthroscopic group had significantly shorter incision length, significantly less intraoperative blood loss, significantly shorter hospital stay, and significantly earlier ambulation postoperatively than the open group(P<0.05). In addition, the proportion of analgesic used postoperatively in the arthroscopic group was significantly lower than the open group(P<0.05). The total early complication rate proved 3.08% in the arthroscopic group,while 14.06% in the open group, which was statistically significant(P<0.05). The follow-up period lasted for more than 1 year.The SF-36 scores significantly increased at 1 year postoperatively in both group compared with those before operation(P<0.05), despite of no statistically significant differences at any corresponding time point between the two groups(P>0.05). At 1 year postoperatively, the excellent and good rate of clinical outcomes proved 92.31% in the arthroscopic group, whereas 95.31%in the open group, which was not statistically significant(P>0.05). [Conclusion] Gluteal muscle contracture patients treated by arthroscopic release is not only effective, but also has the characteristics of less trauma, fewer complications, less pain and quick recovery.
引文
[1]Xu J,Geng X,Muhammad H,et al.Comparison of the incisions for the open surgical treatment of gluteal muscle contracture[J].J Pediatr Orthop B,2014,23(5):435-440.
[2]李智勇,路云翔,陈郁鲜,等.臀肌挛缩症镜下分型及疗效分析[J].中国矫形外科杂志,2016,24(5):427-431.
[3]Zhang X,Jiang X,He F,et al.Arthroscopic revision release of gluteal muscle contracture after failed primary open surgery[J].Int Orthop,2017,41(8):1521-1526.
[4]任士友,江长青,李伟,等.关节镜下射频松解与开放手术治疗臀肌挛缩症疗效比较的Meta分析[J].中国组织工程研究,2014,18(33):5407-5412.
[5]王栋,赵波,李锋涛,等.小切口潜行松解术与传统手术治疗臀肌挛缩症的临床效果比较[J].广西医学,2016,38(6):859-861.
[6]刘礼金,汤武兵,闵志海.关节镜下射频消融技术在治疗臀肌挛缩症中的应用价值[J].实用临床医学,2015,16(11):44-46,108.
[7]任晓东,华南,石立刚,等.关节镜治疗臀肌挛缩症的疗效观察[J].中国微创外科杂志,2015,15(3):245-247.
[8]Zhang T,Xu S,Li H,et al.Comparison of the clinical effects of arthroscopic surgery vs.open surgery for grade II gluteal muscle contracture in adults[J].Exp Ther Med,2018,16(1):364-369.
[9]谢文瑾,李小飞,盛路新.关节镜下微创治疗臀肌挛缩症18例分析[J].中国现代医药杂志,2014,16(7):82-83.
[10]唐翔宇,刘玉杰,李春宝,等.臀肌挛缩症功能量化评分表的信效度检验[J].中国矫形外科杂志,2017,25(4):336-339.
[11]孙晟轩,葛州,董启榕,等.关节镜微创治疗成年人臀肌挛缩症的效果[J].中国医药导报,2018,15(15):80-83.
[12]宋世锋,张伟,刘立柱,等.成年人臀肌挛缩症的手术治疗[J].中国矫形外科杂志,2014,22(19):1797-1799.
[13]尤田,张新涛,张文涛,等.臀肌挛缩症发病机制的研究进展[J].中国矫形外科杂志,2016,24(13):1201-1203.
[14]Zhang X,Ma Y,You T,et al.Roles of TGF-β/Smad signaling pathway in pathogenesis and development of gluteal muscle contracture[J].Connect Tissue Res,2015,56(1):9-17.
[15]俞洁,赵晨光,许刚,等.S1P在臀肌挛缩症发病过程中的表达及作用[J].山西医科大学学报,2014,45(9):799-802.
[16]Al Bayati M A,Kraidy B K.Gluteal muscle fibrosis with abduction contracture of the hip[J].Int Orthop,2016,40(3):447-451.
[17]魏文东,谭响.关节镜监视下射频治疗臀肌挛缩症的疗效观察[J].广西医学,2014,36(4):447-449.
[18]郭勇,苏莲英,丁勇,等.关节镜下射频松解与开放手术治疗臀肌挛缩症疗效比较[J].西部医学,2014,26(2):234-236.
[19]王鼎,杨鹏,张朝鸣,等.关节镜下射频松解与开放手术治疗臀肌挛缩症的效果比较[J].广东医学,2016,37(21):3206-3208.
[20]国永忠.手术治疗注射性臀肌挛缩症的疗效分析[J].系统医学,2017,2(4):77-79.
[21]朱勇,吴昭克,徐新强,等.关节镜下治疗臀肌挛缩症19例[J].中国中医骨伤科杂志,2016,24(5):66-67.
[22]沈鹏飞,侯为林,陈俭波,等.关节镜微创治疗臀肌挛缩症[J].临床骨科杂志,2015,18(1):124-124.
[23]方勇,廖中亚,凡有非,等.关节镜在臀肌挛缩症中的应用效果[J].安徽医学,2017,38(2):215-216.
[24]唐翔宇,李春宝,刘玉杰,等.关节镜下大转子周围组织松解术治疗臀肌挛缩症[J].中国骨与关节杂志,2017,6(9):661-664.
[25]何正惠,黄颂安,蒋礼源.关节镜下治疗臀肌挛缩症疗效观察[J].微创医学,2015,10(5):607-609.
[26]徐毅.臀肌挛缩症的关节镜微创治疗[J].长江大学学报(自科版),2014,11(18):7-8.
[27]柴俊.关节镜下等离子刀治疗成年人肌挛缩症的术后随访研究[D].山东大学,2016:3-8.
[2]李智勇,路云翔,陈郁鲜,等.臀肌挛缩症镜下分型及疗效分析[J].中国矫形外科杂志,2016,24(5):427-431.
[3]Zhang X,Jiang X,He F,et al.Arthroscopic revision release of gluteal muscle contracture after failed primary open surgery[J].Int Orthop,2017,41(8):1521-1526.
[4]任士友,江长青,李伟,等.关节镜下射频松解与开放手术治疗臀肌挛缩症疗效比较的Meta分析[J].中国组织工程研究,2014,18(33):5407-5412.
[5]王栋,赵波,李锋涛,等.小切口潜行松解术与传统手术治疗臀肌挛缩症的临床效果比较[J].广西医学,2016,38(6):859-861.
[6]刘礼金,汤武兵,闵志海.关节镜下射频消融技术在治疗臀肌挛缩症中的应用价值[J].实用临床医学,2015,16(11):44-46,108.
[7]任晓东,华南,石立刚,等.关节镜治疗臀肌挛缩症的疗效观察[J].中国微创外科杂志,2015,15(3):245-247.
[8]Zhang T,Xu S,Li H,et al.Comparison of the clinical effects of arthroscopic surgery vs.open surgery for grade II gluteal muscle contracture in adults[J].Exp Ther Med,2018,16(1):364-369.
[9]谢文瑾,李小飞,盛路新.关节镜下微创治疗臀肌挛缩症18例分析[J].中国现代医药杂志,2014,16(7):82-83.
[10]唐翔宇,刘玉杰,李春宝,等.臀肌挛缩症功能量化评分表的信效度检验[J].中国矫形外科杂志,2017,25(4):336-339.
[11]孙晟轩,葛州,董启榕,等.关节镜微创治疗成年人臀肌挛缩症的效果[J].中国医药导报,2018,15(15):80-83.
[12]宋世锋,张伟,刘立柱,等.成年人臀肌挛缩症的手术治疗[J].中国矫形外科杂志,2014,22(19):1797-1799.
[13]尤田,张新涛,张文涛,等.臀肌挛缩症发病机制的研究进展[J].中国矫形外科杂志,2016,24(13):1201-1203.
[14]Zhang X,Ma Y,You T,et al.Roles of TGF-β/Smad signaling pathway in pathogenesis and development of gluteal muscle contracture[J].Connect Tissue Res,2015,56(1):9-17.
[15]俞洁,赵晨光,许刚,等.S1P在臀肌挛缩症发病过程中的表达及作用[J].山西医科大学学报,2014,45(9):799-802.
[16]Al Bayati M A,Kraidy B K.Gluteal muscle fibrosis with abduction contracture of the hip[J].Int Orthop,2016,40(3):447-451.
[17]魏文东,谭响.关节镜监视下射频治疗臀肌挛缩症的疗效观察[J].广西医学,2014,36(4):447-449.
[18]郭勇,苏莲英,丁勇,等.关节镜下射频松解与开放手术治疗臀肌挛缩症疗效比较[J].西部医学,2014,26(2):234-236.
[19]王鼎,杨鹏,张朝鸣,等.关节镜下射频松解与开放手术治疗臀肌挛缩症的效果比较[J].广东医学,2016,37(21):3206-3208.
[20]国永忠.手术治疗注射性臀肌挛缩症的疗效分析[J].系统医学,2017,2(4):77-79.
[21]朱勇,吴昭克,徐新强,等.关节镜下治疗臀肌挛缩症19例[J].中国中医骨伤科杂志,2016,24(5):66-67.
[22]沈鹏飞,侯为林,陈俭波,等.关节镜微创治疗臀肌挛缩症[J].临床骨科杂志,2015,18(1):124-124.
[23]方勇,廖中亚,凡有非,等.关节镜在臀肌挛缩症中的应用效果[J].安徽医学,2017,38(2):215-216.
[24]唐翔宇,李春宝,刘玉杰,等.关节镜下大转子周围组织松解术治疗臀肌挛缩症[J].中国骨与关节杂志,2017,6(9):661-664.
[25]何正惠,黄颂安,蒋礼源.关节镜下治疗臀肌挛缩症疗效观察[J].微创医学,2015,10(5):607-609.
[26]徐毅.臀肌挛缩症的关节镜微创治疗[J].长江大学学报(自科版),2014,11(18):7-8.
[27]柴俊.关节镜下等离子刀治疗成年人肌挛缩症的术后随访研究[D].山东大学,2016:3-8.