Diagnosis and suegical treatment of severe gluteus maximus contracture

Objective The present was to make the diagnosis in order to improve the effects of oper-ation for the patients with severe gluteus maximus contracture.Methods Of 1856cases,89patients were diagnosed as severe gluteus maximus contracture treated in our hospital between September1993and Octo-ber2001.The diagnostic criteria was depending on the following symptoms and signs:1)Anterolateral shift gait;2)Kyphosis of spine,over abduction of hip in standing,and frog legs while sitting and squatting;3)A-trophy of gluteus maximus while other muscles normal.When patients were on the hip flexion more than90°,they were forced on hip abduction more than45°;4)Normal pelvic and vertebral X-ray findings.Pa-tients who had longer history could have the compensation alteration of kyphosis and increase of anteversion angle of the neck of femur.All patients had undertaken operation of upwards shift of the insertion of gluteus maximus,74cases(91%)of them had undertaken severing and release of gluteus medius and minimus,34cases(38.2%)underwent subcutaneous tissue incision and skin releasing,50cases(56.2%)had undertakenZskin elongation,5cases(5.6%)receivedLskin flap transposition or free skin grafting on cutaneous deficiency area.Results The wound healed at one stage in all patients.Eighty-two patients were followed up from12to36months(mean,28months).All patients were satisfactory with their postoperative improve-ments.Eighty(97.6%)patients were free from kyphosis and pelvic retroversion;69(84.15%)patients were almost recovered to normal gait;12(14.63%)patients remained mild swinging gait;1(1.22%)patient was still crippled.Comparing with preoperative condition,the hip flexion was improved with an average93°.when patients were on hip abduction90°,hip adduction was improved with an average76.1°,7(8.5%)patients had unilateral abduction weakness.2(2.5%)cases had bilateral abduction weakness.There is no significant difference between the recovery levels of the hip functions of the patients from1to3year follow up.Con-clusion Combined therapy of gluteus myotomy,release of gluteus medius and minimus with transfer of the insertion of glutens maximus upwards and skin elongation or skin grafting operations may gain satisfactory effects for patient with severe gluteus maximus contracture.