Myths about the treatment of gluteus contracture (ectropion, frog leg) Myth 1: The contracture must be removed during surgery Correct treatment concept: The contracture tissue of gluteus contracture does not need to be removed during surgery, as long as it is cut off is sufficient. Reason: 1, one end of the contracture tissue is connected to the elastic muscle tissue, once cut off, it will be pulled away by the elasticity of the muscle to form a defect area, which will be extended to a sufficient length, and it is impossible for the contracture tissue to grow back together directly to the original contracture length; therefore, it is meaningless to cut off the contracture tissue. 2, after cutting off the contracture tissue to form the defect area needs to be refilled to restore continuity, the more the defect area is removed, the larger the defect area is, the larger the defect area is, the slower the repair. Therefore, it is wrong to rely on the removal of contracture tissue to lengthen the contracture tissue, then the view that the more thorough the removal, the more it can be lengthened is even more wrong; the removal of contracture tissue does not have any benefit except for causing more trauma and pain to the patient. Myth 2: Surgery must be performed with direct vision Correct treatment concept: The surgical plan for gluteus contracture can be blinded during surgery as long as damage to the sciatic nerve can be avoided and the contracture tissue can be accurately determined and cut. Reason: 1. The purpose of direct vision for gluteus contracture surgery is to avoid injury to the sciatic nerve and to accurately determine and cut off the contracture tissue. Can direct vision necessarily solve both problems? The fact that there have been many cases of direct vision surgery to cut the sciatic nerve and many cases of unsatisfactory results proves that direct vision alone cannot solve these problems. Where does the problem lie? The answer to this question is simple: the surgeon does not understand the principle of pathogenesis and treatment before surgery, is not familiar with the anatomical structure during surgery, relies excessively on the eyes to judge and ignores other safety programs; in fact, surgery and all things in the world to judge its reality is not possible with the eyes alone, must be combined with other measures to comprehensive judgment. 2, if the hip contracture surgery program is completely disconnected from the sciatic nerve, the judgment of the contracted tissue and cut off the direct vision, then direct vision is meaningless in this program; so there is no need to make an incision to see the structure for direct vision, and there is no need to use expensive arthroscope to see; then this program can be completely blind and safer than direct vision, more accurate efficacy It is also more effective and less traumatic than direct vision. 3.The safest and most effective way to protect blood vessels, nerves and important structures of human body is to avoid them by the designed surgical plan, rather than by the intraoperative direct vision. 4, to ensure the accuracy and effectiveness of surgical procedures on diseased tissues is to rely on the designed surgical plan to accurately and completely find them, rather than relying on intraoperative direct vision. The current minimally invasive treatment of gluteus contracture with a peel knife has reached the point where the contracted tissues are accurately judged and cut under blinded conditions, and the entire surgery is completely disconnected from the sciatic nerve; therefore, it is wrong to emphasize that all gluteus contracture surgical protocols must be performed with direct vision. Myth 3: Treatment of gluteus contracture is not effective, especially for adult patients. Correct treatment philosophy: gluteus contracture is curable and effective, and can be completely cured in adults as well with the right approach. It was 15 years ago that the treatment of gluteus contracture was not effective. Since 1990, when Director Sun Hongwei chose the surgical incision for gluteus contracture in the greater trochanteric area [Sun Hongwei, Wang Zhaoxiang, Lu Microwave et al. Gluteus contracture. Tianjin Medicine, 1993, 21 (Suppl.): 58-59.], the problem of poor outcome has been completely solved (unless the incision was chosen in the wrong place and deviated from the greater trochanteric area). Since the scope and degree of contracture tissue in adults are heavier than in children, the results are definitely not satisfactory if adults are treated with the experience of children; adult treatment requires that all contracture tissues other than the skin must be completely cut loose on the operating table, which can be completely curable in adults as well. Myth 4: Mild or incomplete surgery of hip contracture can be treated by massage and exercise. The correct treatment concept: massage and exercise are not a substitute for surgery for gluteus contracture. Once the contracture is formed, it cannot be completely cured by massage and exercise alone, and only surgery can completely relieve the symptoms of gluteus contracture. Myth 5: As long as the surgery is convenient, the operator does not need to consider the size of the incision. Correct treatment concept: Under the premise of ensuring the safety and thoroughness of surgery, the operator should give priority to the smaller the incision, the better. Every patient who undergoes surgery has two basic rights: 1. the right to receive the most traumatic surgery so that the body is less disturbed by the surgery: the less the traumatic interference of the surgery, the less the normal structure that the patient needs to destroy due to the surgical operation, the faster the recovery of the patient’s body after surgery, the sooner the patient can enjoy a healthy and normal life. 2, maintain the skin integrity to enjoy the power of beauty: the integrity of the skin is the most important part of human beauty, the operator can not because the patient to turn to your surgical treatment without trying to maintain the integrity of the patient’s skin; each operator should give priority to achieving the purpose of surgery while destroying the integrity of the patient’s skin as little as possible. Myth #6: The longer the procedure, the better the care. Correct treatment concept: Under the premise of ensuring the safety and thoroughness of surgery, the surgeon should do his best to shorten the operation time and avoid excessive injury to the patient under prolonged anesthesia and being operated on; the surgeon should continuously improve his personal skills to create conditions for the patient to avoid excessive injury; the surgeon should not use careful surgery as a reason for not improving his rapid surgery technique to cause the patient to prolong the operation time. Myth 7: Adhesions release or separation are uniformly done with one method or instrument. Correct treatment concept: Different methods and instruments should be used to separate different degrees of adhesions at different sites; separation should be accurate, rapid and complete, and should not be bound by methods and instruments. (For example, loose adhesions in the abdominal or thoracic cavity can be separated by clamping or wrapping with fingers or pliers, while tighter adhesions, especially girdle-like tissues, must be separated sharply with knives and other instruments. Various types of periosteal strippers are commonly used for orthopedic separation, and various types of nerve strippers are commonly used for neurosurgical separation, but tighter adhesions, especially girdle-like tissues, must be sharply separated with knives and scissors. (Each surgeon has his or her own usual method of separation according to his or her technical proficiency; in the same place, a general surgeon has to use sharp separation for a long time, while a high-level surgeon can quickly solve the problem with sharp separation.)