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

双侧注射性臀肌挛缩症（Bilateral injectable gluteal muscle contracture） 双侧注射性臀肌挛缩症(Bilateral injectable gluteal muscle contracture) Hospital records Samuel wu, male, 19 years old, the han nationality, unmarried, hunan provincialism, who lives in town of fenghuang county tuojiang river in hunan province, on June 22, 2008, was hospitalized, June 22, 2008, collected the history, history of my statement, and reliable. Main complaint: the limitation of double hip joint activity gradually increased more than 10 years. Hpi: patients with childhood disease because of frequent visits to a local hospital, intramuscular injection drug treatment, walking after their parents found that children with mild bilateral hip activities is limited, to hip flexion, at that time, without treatment, parents recently found in children with symptoms aggravate, bilateral hip discomfort while standing. Therefore, we sought treatment in our hospital, with "bilateral injection gluteus contracture". The patient has a good mental health, diet and two normal, no wandering joint pain, no fever, night sweats, and other symptoms. Previous history: denial of hypertension, diabetes history. Denial of hepatitis infection history. No history of blood transfusion, no history of trauma. No history of drug allergy. Vaccination is conducted by society. Personal history: born in origin. No contact history of contaminated water or epidemic area, no contact history of radioactive poisons. Unmarried. Family history: parent body, denial of familial, hereditary disease history. Physical check Temperature: 35.2 ?, pulse is 74 / cent, 19 times/min breathing, blood pressure is 100/60 MMHG. Normal development, medium nutrition, clear mind, step into the ward, automatic position, physical examination and cooperation. Whole body skin, mucous membrane is not yellow dye, the body superficial lymphatic section does not reach the enlargement. There is no deformity of the head, no swelling of the eyelids, no yellowing of the sclera, large circle of bilateral pupil, etc., which is sensitive to light reflex. There is no deformity in the auricle, there is no suppurative secretion in the external auditory canal, and there is no tenderness in the mastoid process. The nasal cavity is good, there is no pus, and there is no tenderness in the sinus. There is no ulceration in the oral mucous membrane, in the center of the tongue, there is no congestion in the pharynx, and the bilateral tonsils are not swollen. The neck is symmetrical, the neck vein is not venous, the neck is soft without resistance, the trachea is in the center, the thyroid is not swollen. Thoracic symmetry, no deformity, bilateral breathing mobility, fibrillation normal, double lung percussion are voiceless, lung and liver dullness is located in between right collarbone midline fifth rib, two lung breath sounds are clear, no smell and wet rale. There is no uplift in the front of the heart, not touching the tremor, the heart rate 78 times/min, the law qi, the various valve areas unsmelling and the noise. Abdominal flatness, total abdominal soft, no tenderness, rebound pain and muscle tension, liver and spleen not touched, abdominal tap drum sound, bowel sound normal. The anus and genitalia are not examined. The spine, bilateral upper limbs and knees, unswelling and abnormal joint movement, double hip examination to see orthopedic condition. Physiological reflection is present and pathologic reflex is not elicited. Orthopaedic condition: bilateral hip symmetry, buttock muscle slightly atrophy, bilateral femoral trochanter in the upper reaches can reach a strip of contracture zone, no tenderness and fluctuation sense. While standing, the knees were naturally closed, and the lower squatting had a "ring sign" in the knee joint, "frog leg sign" positive, 4-word test negative, Ober's sign positive. Double hip joint range: 120 ? 0 ? to 10 ?. Both knees and ankles are normal and the legs feel normal. Laboratory and special examinations No. A preliminary diagnosis was made Bilateral injection gluteal muscle contracture of bilateral injectable gluteal muscle contracture Dong Guixian The 2008-6-22 The situation is true and the signature agrees: 2008-6-22 course records Samuel wu, male, 19 years old, the han nationality, unmarried, hunan provincialism, who lives in hunan province jiantuo river town, main "double hip limited activity gradually increased more than 10 years" on June 22, 2008 to the hospital. I. case features: 1. Male, 19 years old. 2. Main symptoms: limited hip joint activity gradually increased over a decade. 3. Physical examination: bilateral hip symmetry, mild atrophy of hip muscles, and a cord contracture of the bilateral femur with no tenderness and fluctuation. While standing, the knees were naturally closed, and the lower squatting had a "ring sign" in the knee joint, "frog leg sign" positive, 4-word test negative, Ober's sign positive. Double hip joint range: 120 ? 0 ? to 10 ?. Both knees and ankles are normal and the legs feel normal. Ii. 1, gluteus contracture disease: multiple in teenagers, has a history of coxal muscle injection, restricted movement gradually developed hip, knees can not be together when next crouching, delimit "circle", "frog leg" positive, Ober 's positive. The patient is highly suspicious of the disease. 2. Hip joint tuberculosis: the age of onset is mostly children and young adults, and the area of the acetabulum > femoral head is > femoral head. The patient suffered from loss of appetite, weight loss, low heat, night sweats, severe hip joint pain, day and night, and sometimes painful knee joint pain. The blood quickened. X tablets saw the fracture of the acetabulum and the femoral head, narrowing the joint space. According to the history, symptoms, signs and imaging findings, the disease can be excluded. 3. Hip osteoarthritis: mostly elderly, but unilateral or left pathogenesis. Hip pain, restricted activity. X tablets saw acetabulum and femoral hyperplasia, edge sclerosis, narrowing of joint space, and cystic changes of acetabulum and femur. According to the history, symptoms, signs and imaging tips, this disease can be excluded. 4, ischemic necrosis of femoral head, femoral head avascular necrosis, pain in the early days often not obvious, after progressive aggravating, can have a limp, difficulty walking and walking helped turn, restricted joint activities, spin and outreach activities within limited is most obvious. X-ray visible weight-bearing area the subchondral bone density increased, femoral head fracture, can appear "new moon", the shape of the femoral head lose round and smooth, serious when collapse, edge of acetabulum bone sclerosis, serious when joint space narrow. The patient can be excluded from the diagnosis according to the history, symptoms, signs and imaging findings. 5, hip pigmentation villi nodular synovitis: onset age as young adults, more risk of knee or hip, hip pain, joint activities is limited, sometimes accompanied by knee pain. The X tablets saw the destruction of bone around the acetabulum, narrowing the joint space. The patient can be excluded from the diagnosis according to the history, symptoms, signs and imaging findings. Preliminary diagnosis: bilateral injection gluteal muscle contracture Iv. The treatment plan: 1. Proposed project: completion time (1) blood, urine, and routine 2008-6-22 (2) blood biochemistry 2008-6-22 (3) blood sink, c-reactive protein 2008-6-22 (4) blood type 2008-6-22 (5) blood coagulation four items: 2008-6-22 (6) four of the serum, 2008-6-22 (7) electrocardiogram and chest film 2008-6-22 2. Treatment: tertiary care, pup. After complete the examination and examination, the choice of operation. Liu yujie chief consultant saw the patient and agreed to the above diagnosis and treatment. Dong Guixian Liu yujie, the chief physician, records the room The patient is in stable condition today, vital signs are normal, without special treatment. Today, liu yujie, the chief doctor, checked the room, listened to the history report and looked at the patient and pointed out that the patient was diagnosed and had the operation. Dong Guixian The director of the office of the director of the office of the management of the university of China The patient was in a stable condition with normal vital signs and no special treatment. The preoperative test was completed and the results were not abnormal. Today, Dr. Wang zhigang, who is in charge of the doctor's office, took a medical history report and looked at the patient and pointed out that the patient's diagnosis was clear. Dong Guixian 2008-6-25 liu yujie, the chief physician, records the room The patient was in a stable condition, with normal vital signs and no special treatment. Today, liu yujie chief medical doctor, After hearing the history of the patient and looking at the patient, he pointed out that the patient had a clear diagnosis and a selective operation. Dong Guixian 2008-6-26 wang zhigang is in charge of the medical records The patient was in a stable condition, with normal vital signs and no special treatment. The preoperative test was completed and the results were not abnormal. Today, Dr. Wang zhigang, who is in charge of the doctor's office, took a medical history report and looked at the patient and pointed out that the patient's diagnosis was clear. Dong Guixian 2008-6-26 preoperative summary Samuel wu, male, 19 years old, the han nationality, unmarried, hunan provincialism, who lives in hunan province jiantuo river town, main "double hip limited activity gradually increased more than 10 years" on June 22, 2008 to the hospital. Preoperative diagnosis: bilateral injectable gluteal muscle contracture Diagnostic criteria: 1. Male, 19 years old. 2. Main symptoms: limited hip joint activity gradually increased over a decade. 3. Physical examination: bilateral hip symmetry, mild atrophy of hip muscles, and a cord contracture of the bilateral femur with no tenderness and fluctuation. While standing, the knees were naturally closed, and the lower squatting had a "ring sign" in the knee joint, "frog leg sign" positive, 4-word test negative, Ober's sign positive. Double hip joint range: 120 ? 0 ? to 10 ?. Both knees and ankles are normal and the legs feel normal. Surgical name: bilateral gluteal muscle contracture under arthroscopy, contracture of contracture Surgical indications and contraindications: the bilateral gluteal muscles of the patient are atrophied and rigid. Now, the patients with hip dysphagia are not able to squatting normally, and the conservative treatment is ineffective and has the indications of surgery. The patient is generally good, and the preoperative examination of cardiopulmonary abdominal surgery is not obvious. There are no surgical contraindications. Preoperative preparation: 1. Routine preoperative examination completed. The patient and the family members of the patient and their families have agreed to the procedure and have signed the procedure. Cover the skin. 4. Fast water in the morning. Surgical planning: a contracture of contracture of the bilateral gluteal muscle contracture is scheduled for June 27, 2008 under the anaesthesia of epidural anesthesia. The patient is liu yujie chief doctor. Surgical precautions: 1. Strict aseptic operation. 2. Operate gently and carefully. 3. Avoid damaging blood vessels and nerves. Postoperative treatment: 1. Primary care, temporary fasting. 2. Prevent infection and support therapy. The postoperative complications and prevention and treatment methods: 1. Infection: strict aseptic operation in the operation, antibiotic prevention of infection after surgery. 2. Adjacent blood vessels and nerve injury: carefully operate to prevent damage to blood vessels and nerves. Hemorrhage after operation: avoid injury to blood vessels, stop the bleeding, and pressure bandage. Dong Guixian 2008-6-26 preoperative discussion Time: June 26, 2008 Ground point: the six department study room. Participants: Dr. Liu yujie, chief consultant, wang zhigang, Dr. Wei democratic management and general education physician. First, the doctor reports the condition and preoperative preparation (abbreviated). Dr. Wei's doctor: the patient was male and had a history of multiple buttock muscles in childhood, mainly for the double hip dysfunction. This patient has a bilateral gluteal contraction arthroscopic subarthroscopy, the surgical treatment of contracture resection, and the operation has been made clear to patients and their families. Dr. Liu yujie: the diagnosis of bilateral gluteal muscle contracture is clear, with dysfunction. After conservative treatment, the treatment of contracture and resection of contracture was done. Preoperative preparation work is perfect, no surgical contraindications, arthroscopic surgery wound is small, I don't agree to open surgery, to prevent postoperative adhesion again, should be performed early function exercise, in order to achieve the desired therapeutic effect. The other physicians had no objection. Dong Guixian The operation records Operation date: June 27, 2008 Preoperative diagnosis: bilateral injection gluteal muscle contracture Postoperative diagnosis: bilateral injectable gluteal muscle contracture Hand surgery: bilateral gluteal muscle contracture under arthroscopy and contracture of contracture Hand art: wang zhigang, careful, dong guixian Intoxication: epidural anesthesia The drunk: he yan Surgical procedure: after the anesthetic, the patient takes the right side of the position, isolated the perineum, suspends the left lower limb, the iodized wine, the alcohol disinfection, the spread of the sterile wipes. 30 ml of saline was injected under the vertex of the left hip trochanter apex. Cut 0.5 cm incision in two places, blunt separation, subcutaneous tissue in inlet pipe and arthroscopy, filled with local tissue, arthroscopy: hip fascia thickening, lateral glutes surface adhesion, planer knives, radio frequency (rf) remove the fascia tissue hyperplasia, mesh cutting fibrotic contracture of the belt and the tuberosity of the iliotibial band; In the hip joint, check the back and forth, stop the bleeding, rinse, the thick gauze pad pressure bandage. Roll over, left side, hanging right lower limb, re-iodine, alcohol disinfection, spread sterile towel. 30 ml of saline was injected under the subcutaneous injection of the right hip trochanter apex. Cut 0.5 cm incision in two places, blunt separation, subcutaneous tissue in inlet pipe and arthroscopy, filled with local tissue, arthroscopy: hip fascia thickening, lateral glutes surface adhesion, planer knives, radio frequency (rf) remove the fascia tissue hyperplasia, mesh cutting fibrotic contracture with tuberosity of the iliotibial band; In the hip joint, check the back and forth, stop the bleeding, rinse, the thick gauze pad pressure bandage. The operation was smooth, the anesthesia was satisfactory, and the patient was returned to the ward. Zhigang wang 2008-6-27 postoperative course records The patients were treated with bilateral gluteal muscle contracture under anaesthesia and contracture of contracture. The operation was smooth, the anesthesia was satisfied, the intraoperative bleeding was 20ml, and the patient was returned to the ward. Secondary nursing, fasting water, anti - inflammation, and rehydration therapy were given. Dong Guixian Liu yujie, the chief physician, records the room The patient's condition is stable, the spirit, the appetite is good, no fever, the wound pain is relieved. To replace the wound dressings today, liu yujie primary care doctor checked the room instructions: pay attention to the wound exudates and instruct the patient to perform functional exercise. Dong Guixian 2008-6-29 wang zhigang is in charge of the medical records The patient is in a stable condition today. He is in good spirits, has been eating and has mild pain. The dressing was good and exuded more than the other. Liu yujie primary care doctor checked room instructions: change medicine on time, and instruct client to perform functional exercise. Dong Guixian 2008-30-30 liu yujie chief medical doctor check room records Today check room, patient condition continues to improve, spirit, appetite good, no fever, wound pain relief. Liu yujie primary care doctor checked room instruction: the patient wound is not seepage, wound healing good. Can be discharged today, ask the patient to strengthen functional exercise, follow the order to carry out. Dong Guixian 2008-6-30 discharge records Samuel wu, male, 19 years old, the han nationality, unmarried, hunan provincialism, who lives in town of fenghuang county tuojiang river in hunan province, the main "double hip limited activity gradually increased more than 10 years" on June 22, 2008 hospital, hospital on June 30, 2008, a total of eight days in hospital. Preoperative diagnosis: bilateral injectable gluteal muscle contracture Diagnostic criteria: 1. Male, 19 years old. Main symptom: bilateral hip is symmetrical, hip muscle atrophy, can reach a line of a kind of contracture belt, have no tenderness and fluctuation feeling. While standing, the knees can be closed naturally and the knees will be "circled" when crouching. "Frog leg sign" positive. 4 word test negative, OBER sign positive. Double hip joint range: 120 ? 0 ? ~ 20 ?. Both knees and ankles are normal and the legs feel normal. Admission diagnosis: bilateral injectable gluteal muscle contracture Treatment: after admission, the patient was prepared before the routine surgery. On 27 June 2008, the patient underwent a bilateral gluteal contracture of the bilateral gluteal muscle contracture under the anaesthesia of epidural and contracture of contracture. Postoperative anti - inflammatory, symptomatic treatment, incisions healed well; No swelling of limbs, good blood transport, good rehabilitation practice, good general condition. Discharge condition: the patient is generally good, the incision has no blood swelling, and the function is good. Discharge diagnosis: bilateral injectable gluteal muscle contracture Discharge doctor's order: 1. Double lower limb function exercise 2, one month after surgery review 3, do not follow the diagnosis Dong Guixian 2007-11-2 discharge records Samuel wu, male, 19 years old, the han nationality, unmarried, hunan provincialism, who lives in town of fenghuang county tuojiang river in hunan province, the main "double hip limited activity gradually increased more than 10 years" on June 22, 2008 hospital, hospital on June 30, 2008, a total of eight days in hospital. Preoperative diagnosis: bilateral injectable gluteal muscle contracture Diagnostic criteria: 1. Male, 19 years old. Main symptom: bilateral hip is symmetrical, hip muscle atrophy, can reach a line of a kind of contracture belt, have no tenderness and fluctuation feeling. When standing, the knees can be closed naturally and the knees will be "circled" and "frog legs" masculine. 4 word test negative, OBER sign positive. Double hip joint range: 120 ? 0 ? ~ 20 ?. Both knees and ankles are normal and the legs feel normal. Admission diagnosis: bilateral injectable gluteal muscle contracture Treatment: after admission, the patient was prepared before the routine surgery. On 27 June 2008, the patient underwent a bilateral gluteal contracture of the bilateral gluteal muscle contracture under the anaesthesia of epidural and contracture of contracture. Postoperative anti - inflammatory, symptomatic treatment, incisions healed well; No swelling of limbs, good blood transport, good rehabilitation practice, good general condition. Discharge condition: the patient is generally good, the incision is not swollen with blood, the function is good. Discharge diagnosis: bilateral injectable gluteal muscle contracture Discharge doctor's order: 1. Double lower limb function exercise 2, one month after surgery review 3, do not follow the diagnosis Dong Guixian