Gluteal muscle contracture release by radiofrequency coblation under the arthroscope (GMC) is not fully understood as a cause of Gluteal muscle contracture (GMC), The cause of GMC is not fully understood, but most believe it is related to repeated intramuscular injections. The prevalence rate of GMC in children is 1%-2.49% in domestic regional surveys, and it mostly occurs in patients who have been injected with benzyl alcohol as a penicillin solvent during infancy and childhood, and also in adults who have been repeatedly injected with other drugs intramuscularly. Since Ma Chengxuan first reported injectable gluteus contracture in children and surgical treatment in 1978, there have been successive reports in China, but they are all treated by open surgery, and no relevant studies have been seen at home and abroad for arthroscopic radiofrequency gasification treatment.
I. Clinical manifestations of gluteus maximus contracture
Most of the gluteus maximus muscle ends at the iliotibial bundle, and the lower deep fibers end at the gluteus node between the lateral femoral muscle and the vastus medialis in the proximal femoral segment. Due to injection gluteus contracture, the gluteus maximus muscle becomes degenerative and fibrotic, and the stretch function and elasticity of the muscle changes.
1. The skin at the injection site in the upper outer quadrant of the buttock is adherent to the subcutaneous fascia, showing a “dimple-like” depression. As the hip contracture belt affects the development of the hip muscle, contracture belt and depression groove appear in the hip, especially obvious when the hip is flexed internally ……2, the hip becomes pointed and cone-shaped when squatting, and the knees cannot come together in sitting and squatting position. When squatting, the hip joint is in an external booth and the knees are separated in a frog position. The hip can be smelled or touched with a popping sensation.
3, abnormal changes in form and gait, walking with the lower limbs in an external “eight” gait.
4. Positive cross-leg test, Ober’s sign and 4-character test.
I. Surgical treatment is considered the most effective treatment method, and it has good effect on improving function and gait. The postoperative gait and function recovery rate is 90.6% to 95.9%. However, open surgery is traumatic, with long incisions and heavy tissue reaction and exudation after electrodebrider electrocoagulation, and some of them affect wound healing or complicate infection. In some cases, the incision is centered on the formation of a new cord-like scar band.
The advantages of arthroscopic surveillance radiofrequency vaporization and release for gluteus contracture
1.Surgery under arthroscopic surveillance has a clear field of view, and blood vessels and nerves can be clearly identified, and the working area is far from the anatomical parts of sciatic nerve, superior and inferior gluteal vessels and nerves, which are not easily damaged.
2.No extensive stripping of muscle tissue, less trauma, less bleeding, no interference with muscle fiber tissue without contracture belt, which can effectively prevent local hematoma formation.
3, open surgery incision length 15-25cm, and this method than the traditional open surgery incision is small, only 5 mm do not have to worry about wound split, postoperative tissue reaction is light, conducive to early functional exercise and rehabilitation.
Third, the surgical method equipment and instruments arthroscopy using 4.0mm diameter 300 wide angle mirror, cold light source, camera imaging system, monitor. Computerized video imaging and capture acquisition system; radiofrequency vaporizer and 900-angle vaporizing electrode head. Planing knife, periosteal stripper, nucleus pulposus occlusion forceps and hook knife for backup.
I. Surgical operation steps
1.Use epidural or general anesthesia, lateral recumbent position. Both sides are disinfected, toweled and operated on separately. The greater trochanter of the femur, the fibrous band of the gluteus contracture, the course of the sciatic nerve and the surgical entrance are marked before surgery.
2.Inject 50 ml of saline containing epinephrine into the area of the gluteal muscle contracture band and inject it into the subcutaneous tissue in order to stop the bleeding.
3, Make a 5mm incision 2-3cm downward from the apex of the greater trochanter of the femur, insert a periosteal stripper, and perform blunt separation along the subcutaneous tissue between the deep sub-M membrane and the surface of the gluteus contracture band, whose cavity is about 5M×5M, and aspirate the fatty tissue in the cavity as the working cavity.
4, 3~4M was opened on both sides of the gluteal muscle contracture belt, and a small 5L incision was made as the radiofrequency vaporization electrode and drainage channel.
5.After the cavity is filled with saline, the fatty tissue on the surface of the gluteus contracture band is removed with a planing knife or medullary biting forceps under arthroscopic surveillance and rinsed to maintain a clear view for surgical operation.
6.Find the edge of the gluteus contracture band and cut the gluteus contracture band with a plasma knife, with the cutting of the band, the gluteus muscle will be expanded.
Second, the problems of surgical attention
1.The sciatic nerve, the superior and inferior gluteal nerves and the greater trochanter of the femur are marked out before the operation so that the operation can operate as a warning, and the sciatic nerve and superior gluteal vessels should be kept away from the operation to avoid accidental injury.
2.In order to prevent local bleeding and keep the intraoperative field clear, 1mg of epinephrine solution is added to every 3000ml of saline within the perfusion solution for continuous flushing.
3.The working angle of the arthroscope and the radiofrequency vaporization electrode is 450-600 to facilitate the surgical operation.
4.The elastic ringing hip should pay attention to the release of the posterior gluteal muscle attachment of the greater trochanter of the femur.
5.Surgical operation should be performed from superficial to deep to cut off the contracture belt layer by layer and not excise it. While vaporizing and cutting, stopping the bleeding, and at the same time carrying out passive flexion and internal rotation and abduction of the hip joint, the operation should be carried out until the hip joint activity is not restricted, there is no popping sound and no active bleeding.
6, should try to avoid stripping muscle tissue, so as not to damage the muscle fibers cause bleeding.
7.If the contracture zone is deep, large or close to the sciatic nerve, arthroscopic operation is difficult, a small incision can be attached to open the operation.
8.If the trauma is large and there is much intraoperative exudation, medical bioprotein gel can be sprayed on the trauma, and drainage tubes can also be placed to prevent hematoma formation.
III. Postoperative treatment
Lateral or supine lying, ice bag compression to stop bleeding. 24h there may be residual fluid or exudation, the external dressing should be changed frequently to keep the wound dry. Functional exercises can be performed on the ground 24h after surgery to prevent adhesions.