To compare the efficacy of Pie-crusting assisted arthroscopy and open surgery in the treatment of gluteal muscle contracture(degree Ⅲ)in children

ZHANG Jian; WANG Bin; ZHAO Hong-bo; WANG Yue-guang; ZHOU Hong-yan; SUN Ming-hong; ZHANG De-xin

doi:10.3969/j.issn.2095-252X.2025.03.006

Abstract：Objective To compare the clinical efficacy of"Pie-crusting"-assisted arthroscopy and open surgery in the treatment of grade Ⅲ gluteal muscle contracture in children.Methods From August 2016 to June 2022,26 children(52 affected sides)with grade Ⅲ injection-induced gluteal muscle contracture were admitted to the Department of Pediatric Orthopedics of Tangshan Second Hospital.Among them,there were 12 boys and 14 girls with an average age of 12.1 years(range:8 to 16 years).Minimally invasive treatment with"Pie-crusting"-assisted arthroscopy was performed on 34 sides(observation group),and open surgery was performed on 18 sides(control group).The length of the surgical incision,the duration of the operation,the intraoperative blood loss,and the postoperative hospital stay were compared between the two groups.The curative effect was comprehensively evaluated by postoperative gait,squatting with knees,crossed-leg test,and bouncing sensation.Results All 26 children(52 affected sides)were followed up for 6 to 36 months,with an average of 13 months.The length of the surgical incision was(1.0±0.3)cm in the observation group and(10.4±2.6)cm in the control group,and the differences were statistically significant(P<0.05).The duration of the operation was(92.4±31.9)minutes in the observation group and(98.2±41.1)minutes in the control group,and there was no statistically significant difference(P>0.05).The intraoperative blood loss was(35.2±14.1)ml in the observation group and(118.2±49.1)ml in the control group,and the differences were statistically significant(P<0.05).The postoperative hospital stay was(3.3±1.6)days in the observation group and(6.0±1.8)days in the control group,and the differences were statistically significant(P<0.05).The incisions of both groups healed by first intention,and there was no occurrence of nerve or blood vessel injury.At the last follow-up,the comprehensive curative effect was evaluated according to the postoperative gait,squatting with knees,crossed-leg test,and bouncing sensation.In the observation group,31 sides were excellent,2 sides were good,and 1 side was poor;in the control group,16 sides were excellent,1 side was good,and 1 side was poor,and there was no statistically significant difference(P>0.05).Conclusions Both"Pie-crusting"-assisted arthroscopic minimally invasive surgery and open surgery have reliable clinical efficacy in the treatment of grade Ⅲ gluteal muscle contracture in children.However,"Pie-crusting"-assisted arthroscopy for gluteal muscle contracture has the advantages of small trauma,less bleeding,and quick recovery,and is more likely to be accepted by children(especially girls).