Gluteal muscle contracture

Introduction The gluteal muscle contracture syndrome is a clinical syndrome characterized by a variety of causes, such as gluteal muscle and fascial fibrosis, contracture, and unique gait and signs caused by hip function limitation. There have been many reports at home and abroad since the 1970 Valderrama report, but the cause is not yet clear. The patient's hip internal rotation is limited. When standing, the external extremity is rotated, and it cannot be completely close. Walking often has an outer eight, a swinging gait, and a quick step is jumping. When you sit down, your legs can't be close together. The hips are separated by a frog-like position, and one side of the thigh is difficult to rest on the other side of the thigh (cross-leg test). When the squatting activity is light, the knees are separated first, then the squatting is followed by the squatting.

Cause

Injection factor

Most scholars agree that the disease is associated with repeated hip injections, and the formation of lumps after intramuscular injection is the manifestation of myofibrillar disease. Lloycl-Roberts and Thomas suggested that edema and hemorrhage at the injection site were found in the pathological examination of children with intramuscular injection, where fibrosis may occur and contraction of the scar leads to contracture. In 1968, William reported that the injection of antibiotics in animal experiments produced an inflammatory reaction. The injection of penicillin diluted with 2% benzyl alcohol was the largest in response to degeneration and necrosis, resulting in fibrosis.

Child susceptibility

Immunity factor. A large number of children receive intramuscular injection, but only a small number of people are affected. The study found that children with gluteal muscle contracture have immunoregulatory dysfunction, TS cells are significantly lower, leading to relatively hyperresponsive TH cells; the immune response caused by the drug hapten after receiving benzyl alcohol injection can not be stopped in time, which is easy to cause immune damage. At the same time, it was observed that children with elevated serum IgG and decreased C3 provided indirect evidence for this.

The human erythrocyte membrane has a receptor, which is a glycoprotein, and red blood cells can recognize and capture immune complexes in the body through the adhesion of receptors on the membrane. 95% of the receptors in circulating blood are located on the erythrocyte membrane, so the main cell that removes immune complexes is red blood cells. The experiment showed that the erythrocyte receptor activity and erythrocyte membrane immune complex levels in children with gluteal muscle contracture were significantly lower than those in normal people, suggesting that the erythrocyte immune function is low in children, and it is unable to adhere and remove the immune complexes produced after drug injection in time.

The ligation method showed deposition of immune complexes in the small vessel wall of the gluteal muscle. Immune complex can cause damage to the blood vessel wall, causing intravascular coagulation to cause hypoxia in the tissue, and then muscle cell damage and activation of fibroblasts eventually cause gluteal muscle fibrosis.

genetic factors.

One case of foreign patients reported bilateral deltoid muscle contracture and gluteal muscle contracture, and the mother also had bilateral deltoid muscle contracture, which could not be explained by intramuscular injection alone, and can be considered to be related to heredity.

Trauma, infection and other factors

Complications after congenital dislocation of the hip. In China, several cases of bilateral congenital dislocation of the hip were treated with open reduction, and gluteal muscle contracture was found from March to April after Salter osteotomy.

The sequela of gluteal compartment syndrome

Infection of the hips.

an examination

Related inspection

Muscle tone examination, neurological examination, serum osteocalcin (BGP)

Pelvic variants: those with a long course of disease may have a acetabular sulcus protruding into the pelvis to form the Otto's pelvis. Children with gluteal small muscle contracture have large trochanter bone hypertrophy. Children with bilateral asymmetrical gluteal muscle contracture may have pelvic tilt and secondary lumbar scoliosis. The severe lateral anterior superior iliac spine is lower on the lighter side, the heavy side umbilical hernia is longer than the light side, and the distance from the greater trochanter to the ankle is equal.

Auxiliary inspection:

X-ray performance was reported as normal. Early surgery at postoperative follow-up contributes to the recovery of the above secondary changes. CT scans showed that the early inflammatory lesions were seen in the density reduction area. In the late stage, the muscle fibers were replaced by connective tissue, and the muscle fibers were replaced by connective tissue. The muscle volume was reduced, the density was increased, and the myofascial gap was widened. When the scar is formed, it will appear as a shadow. Scanning provides valuable clinical data on the location, extent and severity of the lesion.

Differential diagnosis

Differential diagnosis of gluteal muscle contracture:

The gluteal muscle paralysis gait: gluteal muscle paralysis gait is a side gluteus medius lesion, polymyositis, progressive malnutrition and so on.

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