高度な弾発股と股関節の機能障害を呈する殿筋拘縮症の治療経験

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概要

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• Muscle contractures as a complication of intramuscular (IM) injections in childhood are widely known; however, since the number of cases is decreasing, recognition of the syndrome is not as high now as it was in the past. We report three patients with contractions of the gluteal muscle who presented with advanced snapping hip syndrome and functional impairment. Three female patients (6 legs) were referred to our clinic with snapping hips and walking disturbances that developed in later childhood; all received IM injections in the gluteal area in earlier childhood. At presentation, all 6 legs were externally subluxated and gait disturbance developed due to abductional contractures and markedly limited leg adduction. One patient underwent surgery on one leg (conservative management was chosen for the other leg) and two patients underwent operations on both legs. The necessary range of fascia and tendon was excised in all cases. Functional improvement was obtained in all cases immediately after the operation. An average of 32 months postoperatively, the outcomes are good and the clinical courses uneventful. The causes of muscle contraction in the gluteal area include injuries, radiotherapy, and IM injections. In severe cases, contractions may lead to functional impairments of the hip joint and cause gait disturbances and snapping hip syndrome, as in the reported cases. The severity of illness is often related to the grade of contractures. Detailed understanding of anatomical and mechanical relationships in the contracted region is required for an operation to be successful. After sufficient excision of the fascia and tendon(s), a favorable postoperative course usually can be obtained.

• 日本関節病学会の論文

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