双侧注射性臀肌挛缩症（Bilateral gluteus muscle contracture）

双侧注射性臀肌挛缩症（Bilateral gluteus muscle contracture） 双侧注射性臀肌挛缩症(Bilateral gluteus muscle contracture) Admission record Wu Shengbo, male, 19 years old, Han nationality, born in Hunan, unmarried, lived in Tuojiang town in Fenghuang County of Hunan Province, was admitted to hospital on June 22, 2008, June 22, 2008 history, history of my statements, reliable. Chief complaint: bilateral hip joint limited motion, gradually aggravating for more than 10 years. History: Patients with childhood disease due to the frequent visits to the local hospital, intramuscular injection of drug treatment, after walking parents found that children with bilateral hip hip flexion with mild limitation was not significantly, after treatment, the parents found that children with symptoms increase recently, standing double side hip discomfort. It came to our hospital for treatment, outpatient with bilateral gluteal muscle contracture "hospital income. Patients from the onset of good spirit, diet and two normal, no wandering joint pain, no fever, night sweats and other symptoms, sleep is acceptable. Past history: deny hypertension, diabetes history. Deny hepatitis and other infectious diseases. No history of blood transfusion, no history of trauma. No history of drug allergy. Vaccination is carried out according to society. Personal history: born in the country of origin. No water, no radioactive area contact history, history of exposure to toxins. Unmarried. Family history: family health, denial of familial and inherited medical history. Physical examination Temperature: 35.2 degrees, the pulse of 74 beats per minute, breathing 19 times / min, the blood pressure of 100/60mmHg. Normal development, moderate nutrition, clear consciousness, into the ward, automatic posture, physical examination cooperation. Whole body skin and mucous membrane do not have yellow dye, the whole body superficial lymph node has not touched swelling. There is no deformity of the head, no puffiness of the eyelids, no yellow staining of the sclera, and large circles of the bilateral pupils, which are sensitive to light reflection. There is no deformity of the auricle, no purulent discharge in the external auditory canal, and no tenderness in the mastoid. Nasal cavity ventilation, no purulent nasal discharge, paranasal sinuses without tenderness. Oral mucosal ulceration, Shenshe center, no hyperemia of pharynx, bilateral tonsils were not enlarged. Neck symmetry, no jugular vein engorgement, neck soft, no resistance, the trachea in the middle, the thyroid is not swollen. Symmetric non thoracic deformity, bilateral breathing, fremitus normal lung percussion is voiceless, lung and liver dullness in the right fifth intercostal space, two respiratory sounds were clear and dry and wet rales at the end. No uplift before the heart, touched the tremor, heart rate 78 beats / min, the law is neat, the valve area without noise. The abdomen flat, full abdomen soft, no tenderness and rebound tenderness and muscle tension, and rib untouched, abdominal percussion drum sound, normal bowel sounds. The anus and genitalia were not examined. The spinal column, upper limbs and knees, feet without swelling and abnormal joint motion were observed in the Department of orthopedics with double hips. Physiological reflex exists, pathological reflex not elicited. Department of orthopedics situation: bilateral buttocks symmetry, buttocks muscle atrophy slightly, bilateral femur big rotor after can touch the strip like contracture belt, no tenderness and wave dynamic. When standing, both knees can be natural and close together. When crouching, the knee joint appears "circle mark", "frog leg sign" is positive, 4 word test is negative, and Ober 's sign is positive. The range of motion of the double hip joint is 120 degrees - 0 degrees - 10 degrees. Both knees and ankles are normal and the lower extremities feel normal. Laboratory and special inspection No. Final diagnosis Bilateral gluteal muscle contracture caused by bilateral injection of gluteal muscle contracture GUI Xian Dong 2008-6-22 The situation is true and the signature agrees: 2008-6-22 course history Wu Shengbo, male, 19 years old, Han nationality, born in Hunan, unmarried, lived in Tuojiang town in Fenghuang County of Hunan Province, the main cause of double hip joint activity limitation gradually increased more than 10 years was admitted to hospital on June 22, 2008. Case features: 1, male, 19 years old. 2, the main symptoms: two hips limited motion, gradually aggravating 10 years. 3, check body: bilateral hip symmetry, hip muscle atrophy slightly, bilateral femur big rotor can touch the upper part of the contracture band, no tenderness and wave dynamic. When standing, both knees can be natural and close together. When crouching, the knee joint appears "circle mark", "frog leg sign" is positive, 4 word test is negative, and Ober 's sign is positive. The range of motion of the double hip joint is 120 degrees - 0 degrees - 10 degrees. Both knees and ankles are normal and the lower extremities feel normal. Two. Prospective interview: 1, gluteal muscle contracture: more than in adolescents, there are hip intramuscular history, and gradually hip joint activities limited, squat knees can not be close together, there is "circle mark", "frog leg" positive, Ober 's sign positive. The patient was highly suspicious of the disease. 2. Tuberculosis of hip joint: the age of onset is mostly in children and young adults. The location of the disease is the acetabulum, the femoral neck and the femoral head. Patients suffer from loss of appetite, loss of weight, low fever, night sweats, severe hip pain, inability to lie flat day and night, and sometimes knee pain. Esr. X showed osteolytic destruction of the acetabulum and femoral head and narrowing of the joint space. According to the medical history, symptoms, signs and imaging findings, the disease can be excluded. 3, hip osteoarthritis: most of the elderly, can be unilateral or left side attack. Suffer from hip pain and limited motion. The X showed acetabular and femoral head hyperplasia, marginal sclerosis, narrowing of the joint space, and cystic changes in the acetabulum and femoral head. According to the medical history, symptoms, signs and imaging findings, the disease can be excluded. In 4, avascular necrosis of the femoral head avascular necrosis in early pain is not obvious, after the gradual increase, may have difficulty walking limp, and crutches, within the rotating joint activities is limited, and outreach activities Limited is the most obvious. X shares the weight-bearing area under visible cartilage bone bone density increased, fragmentation can occur, "crescent sign", the femoral head lost round and smooth appearance, severe collapse, the acetabular rim bone sclerosis, severe narrowing of joint space. The patient was excluded from the diagnosis based on medical history, symptoms, signs, and imaging findings. 5. Pigmented villonodular synovitis of hip joint: the onset age is mostly young and middle-aged, the incidence of knee or hip joint, hip pain, limited joint motion, and sometimes accompanied by knee pain. In the X film, osteolytic destruction around the acetabular fossa and narrowing of the joint space were seen. The patient was excluded from the diagnosis based on medical history, symptoms, signs, and imaging findings. Three. Initial diagnosis: bilateral gluteus contracture Four. Diagnosis and treatment plan: 1. planned items: completion time (1) routine 2008-6-22 of blood, urine and stool; (2) blood biochemical 2008-6-22 (3) ESR and C- reactive protein 2008-6-22 (4) blood type 2008-6-22 (5) blood coagulation four items, 2008-6-22 (6) serum four item 2008-6-22; (7) ECG and chest X-ray 2008-6-22 2, treatment: three levels of care, general food. Improve the relevant laboratory and examination, elective surgery. Dr. Liu Yujie visited the patient and agreed to the diagnosis and treatment GUI Xian Dong 2008-6 - 23 records of ward rounds by Liu Yujie's chief physician The patient's condition is stable today, the vital signs are normal, and there is no special treatment. Today, Dr. Liu Yujie visits the ward, listens to the history report and looks at the patient. He points out that the patient has a definite diagnosis and an elective operation. GUI Xian Dong Wang Zhigang 2008624 physician in charge of checking record Patients with stable condition, signs of normal life, no special treatment. Preoperative laboratory tests have been completed and no abnormal returns have been reported. Today, Wang Zhigang is in charge of the ward rounds. After listening to the history report and checking the patient, he points out that the patient is well diagnosed, fully prepared and scheduled for surgery. GUI Xian Dong 2008-6 - 25 records of ward rounds by Liu Yujie's chief physician Patients with stable condition, signs of normal life, no special treatment. Today, Dr. Liu Yujie visits the ward, listens to the history report and looks at the patient. He points out that the patient has a definite diagnosis and an elective operation. GUI Xian Dong Wang Zhigang 2008626 physician in charge of checking record Patients with stable condition, signs of normal life, no special treatment. Preoperative laboratory tests have been completed and no abnormal returns have been reported. Today, Wang Zhigang is in charge of the ward rounds. After listening to the history report and checking the patient, he points out that the patient is well diagnosed, fully prepared and scheduled for surgery. GUI Xian Dong Summary of 2008-6-26 before operation Wu Shengbo, male, 19 years old, Han nationality, born in Hunan, unmarried, lived in Tuojiang town in Fenghuang County of Hunan Province, the main cause of double hip joint activity limitation gradually increased more than 10 years was admitted to hospital on June 22, 2008. Preoperative diagnosis of bilateral gluteal muscle contracture Diagnosis basis: 1, male, 19 years old. 2, the main symptoms: two hips limited motion, gradually aggravating 10 years. 3, check body: bilateral hip symmetry, hip muscle atrophy slightly, bilateral femur big rotor can touch the upper part of the contracture band, no tenderness and wave dynamic. When standing, both knees can be natural and close together. When crouching, the knee joint appears "circle mark", "frog leg sign" is positive, 4 word test is negative, and Ober 's sign is positive. The range of motion of the double hip joint is 120 degrees - 0 degrees - 10 degrees. Both knees and ankles are normal and the lower extremities feel normal. Operation name: bilateral gluteal muscle contracture, arthroscopic release and resection of contracture band Indications and contraindications: bilateral gluteal muscles atrophy and stiffness, and now patients with hip joint movement disorders, not normal squatting, conservative treatment is invalid, there are indications of operation. The patient was in good condition, and there was no obvious abnormality in the examination of heart, lung and abdomen before operation. No operation contraindication was found. Preoperative preparation: 1. Routine preoperative examination was completed. 2, patients and their families have been described, intraoperative and postoperative complications and risks may occur, patients and their families expressed understanding, consent to surgery, has signed. 3, skin. 4, morning water fasting. Surgical planning: bilateral gluteal muscle contracture, arthroscopic release, and resection of the contracture band, under epidural anesthesia, are scheduled for June 27, 2008. The surgeon is Liu Yujie's chief physician. Precautions for operation: 1. Strict aseptic operation. 2 、 operate gently and carefully. 3, avoid damage to blood vessels, nerves and so on. Postoperative treatment: 1, primary care, temporary fasting water. 2, prevention of infection, symptomatic support treatment. Postoperative complications and prevention measures: 1. Infection: strict aseptic operation, postoperative antibiotic prophylaxis. 2, adjacent vascular and nerve injuries: careful operation, to prevent damage to blood vessels, nerves and so on. 3, postoperative secondary bleeding: to avoid damage to blood vessels, hemostasis, pressure bandaging. GUI Xian Dong Discuss 20086-26 before operation Time: June 26, 2008 Setting: bone six study room. Participants: Liu Yujie's attending physician, Wang Zhigang, Wei Min, chief physician and all refresher physicians. First of all, the doctor reported the condition and the preparation before the operation. Dr. Wei is in charge of the doctor: the patient is male, there are many times in childhood history of gluteal muscle injection, mainly for double hip joint dysfunction. The patient had bilateral gluteal muscle contracture, arthroscopic release and resection of the contracture band. The surgical indications were clear to the patient and his family. Dr. Liu Yujie's chief physician: bilateral gluteal muscle contracture in this patient was diagnosed with dysfunction. After conservative treatment, arthroscopic lysis and resection of contracture band were feasible. Preoperative preparation work has been perfect, no surgical contraindications, arthroscopic surgery of small wound, I do not agree to open surgery to prevent postoperative adhesion, early functional exercise system, to achieve the desired treatment effect. Other doctors have no objection. GUI Xian Dong Operation record Date of operation: June 27, 2008 Preoperative diagnosis: bilateral injection of gluteal muscle contracture Diagnosis after surgery: bilateral injection of gluteal muscle contracture Operation: bilateral gluteal muscle contracture, arthroscopic release and resection of the contracture band Operation: Wang Zhigang, careful, Dong Guixian Anesthesia: epidural anesthesia Anesthesia: He Yan After the operation: after the success of anesthesia, patients get the right lateral position and the isolation of perineum, left lower limb suspension, intraoperative iodine, alcohol disinfection, sterile towel. Subcutaneous injection of 30 ml of normal saline at the apex of the great trochanter of the left hip. Cut 0.5 cm incision two, blunt dissection of the subcutaneous tissue into the water inlet pipe and arthroscopy, filling local tissue under arthroscopy: hip lateral surface of gluteus maximus fascial thickening, adhesion and removal of fascia tissue hyperplasia with knives, RF, mesh belt and cut off the fibrosis contracture of the iliotibial band tuberositas movement; check before and after snapping hip, disappear, hemostatic, rinse, thick gauze bandage. Turn over, lying on the left side, the right lower limb suspension, re iodine, alcohol disinfection, sterile towel. 30 ml of normal saline was injected subcutaneously at the greater trochanter of the right hip. Cut 0.5 cm incision two, blunt dissection of the subcutaneous tissue into the water inlet pipe and arthroscopy, filling local tissue under arthroscopy: hip lateral surface of gluteus maximus fascial thickening, adhesion and removal of fascia tissue hyperplasia with knives, RF, mesh cut fibrosis contracture with iliotibial tract trochanteric hip movement; joint inspection before and after snapping away, hemostatic, rinse, thick gauze bandage. The operation was successful and the anesthesia was satisfactory. The patient returned to the ward safely. Wang Zhigang The postoperative course 2008627 records Patients with bilateral gluteal contracture, arthroscopic release and resection of the contracture band were performed under epidural anaesthesia today. The operation was satisfactory, anesthesia was satisfactory, intraoperative bleeding was 20ml, and the patient returned to the ward safely. After the operation, two levels of nursing, fasting water, anti inflammation and rehydration therapy were given. GUI Xian Dong 2008-6 - 28 records of ward rounds by Liu Yujie's chief physician Patients with stable condition, good spirit, good appetite, no fever, pain reduction. Change the wound dressing 1 times today. Liu Yujie's chief physician's ward round instruction: pay attention to the exudation of the wound and instruct the patient to perform functional exercises under the ground. GUI Xian Dong Wang Zhigang 20086-29 physician in charge of checking record The patient is stable today, has good spirit, has eaten, and has mild pain in the cut. The change of dressing showed good incision and more exudation. Liu Yujie's ward instruction: change the dressing on time and instruct the patient to perform physical exercises. GUI Xian Dong 2008-6-30 records of ward rounds by Liu Yujie's chief physician Today's rounds, patients continue to improve, the spirit, appetite, no fever, cut pain relief. Dr. Liu Yujie's ward instruction showed that the wound was free of exudation and the wound healed well. Today may leave the hospital, instruct the patient to strengthen the function exercise, obeys the instruction to carry out. GUI Xian Dong 2008630 discharge records Wu Shengbo, male, 19 years old, Han nationality, born in Hunan, unmarried, lived in Tuojiang town in Fenghuang County of Hunan Province, the main cause of double hip joint activity limitation gradually increased more than 10 years was admitted to hospital on June 22, 2008, from the hospital in June 30, 2008, a total of 8 days of hospitalization. Preoperative diagnosis of bilateral gluteal muscle contracture Diagnosis basis: 1, male, 19 years old. 2, the main symptoms: bilateral hip symmetry, hip muscle atrophy, can touch the cord like contracture band, No tenderness and wave motion. When standing, both knees can be naturally joined together. When crouching, both knees have a "turn around sign" and "frog leg sign" is positive. 4 word test negative, OBER sign positive. The range of motion of the double hip joint is 120 degrees - 0 degrees - 20 degrees. Both knees and ankles are normal and the lower extremities feel normal. Admission diagnosis: bilateral injection of gluteal muscle contracture After treatment, routine preoperative preparation was performed, and bilateral gluteal muscle contracture, arthroscopic release and resection of the contracture band were performed under epidural anesthesia in June 27, 2008. Postoperative anti-inflammatory and symptomatic treatment, the incision healed well, no swelling of the limbs, good blood flow, rehabilitation exercises, in good condition. Discharge situation: the patient is in good condition, the incision is free of oozing of blood, and the function is good. Discharge diagnosis: bilateral injection of gluteal muscle contracture Discharge orders: 1, 2 pairs of lower limbs function exercises, 3 months after the operation review, discomfort follow-up GUI Xian Dong 2007112 discharge records Wu Shengbo, male, 19 years old, Han nationality, born in Hunan, unmarried, lived in Tuojiang town in Fenghuang County of Hunan Province, the main cause of double hip joint activity limitation gradually increased more than 10 years was admitted to hospital on June 22, 2008, from the hospital in June 30, 2008, a total of 8 days of hospitalization. Preoperative diagnosis of bilateral gluteal muscle contracture Diagnosis basis: 1, male, 19 years old. 2, the main symptoms: bilateral hip symmetry, hip muscle atrophy, can touch the strip like contracture band, no tenderness and wave motion. When standing, both knees can be naturally joined together. When crouching, both knees have a "turn around sign" and "frog leg sign" is positive. 4 word test negative, OBER sign positive. The range of motion of the double hip joint is 120 degrees - 0 degrees - 20 degrees. Both knees and ankles are normal and the lower extremities feel normal. Admission diagnosis: bilateral injection of gluteal muscle contracture After treatment, routine preoperative preparation was performed, and bilateral gluteal muscle contracture, arthroscopic release and resection of the contracture band were performed under epidural anesthesia in June 27, 2008. Postoperative anti-inflammatory and symptomatic treatment, the incision healed well, no swelling of the limbs, good blood flow, rehabilitation exercises, in good condition. Discharge situation: the patient is in good condition, the incision is free of oozing of blood, and the function is good. Discharge diagnosis: bilateral injection of gluteal muscle contracture Discharge orders: 1, 2 pairs of lower limbs function exercises, 3 months after the operation review, discomfort follow-up GUI Xian Dong