Recommendation of the best site based on the distribution pattern of extramuscular and intramusular nerves for gluteal muscle injection / Recomendación del mejor sitio para la inyección del músculo glúteo basado en el patrón de distribución de los nervios extramusculares e intramusculares

To reveal the extra- and intramuscular nerve distribution patterns of the gluteus maximus, medius, and minimus, and to provide guidance for gluteal muscle injection in order to avoid nerve injury. Ten adult and 10 child cadavers were used. The superior and inferior gluteal nerves innervating the gluteus maximus, medius, and minimus were dissected, exposed, and sutured in-situ on the muscle. The three gluteal muscles were removed, and the distribution patterns of the intramuscular nerves were revealed by modified Sihler's nerve staining. The nerve distribution pattern was returned to the corresponding position in the body, and the patterns in the four quadrants of the buttock were analyzed. There were 3-12 extramuscular nerve branches of the gluteus maximus, medius, and minimus. After entering the muscle, these nerve branches arborized and anastomosed to form an arc-shaped, nerve-dense zone. The nerve distribution was most dense in the inferomedial region of the superolateral quadrant and the inferolateral region of the superomedial quadrant of the buttocks. The nerve distribution was relatively dense in the inferolateral region of the superolateral quadrant, and the medial region of the inferomedial quadrant. An arc-shaped, nerve-sparse zone in the superolateral and superomedial quadrants near the lower iliac crest accounted for about two-fifths of the two quadrants' limits. The arc-shaped, nerve-sparse zone in the superolateral quadrant is the preferred injection site, and the superomedial quadrant near the lower iliac crest is also recommended as a gluteal intramuscular injection region, free from nerve injury.

El objetivo de este trabajo fue revelar los patrones de distribución nerviosa extramusculat e intramuscular de los músculos glúteo máximo, medio y mínimo y proporcionar orientación para la inyección en la región glútea con el propósito de evitar lesiones nerviosas. Se utilizaron diez cadáveres adultos y diez niños. Los nervios glúteos superior e inferior que inervan a los músculos glúteo máximo, medio y mínimo fueron disecados, expuestos y suturados in situ en el músculo. Se extirparon los tres músculos glúteos y se revelaron los patrones de distribución de los nervios intramusculares mediante la tinción nerviosa de Sihler modificada. El patrón de distribución nerviosa se devolvió a la posición correspondiente en el cuerpo y se analizaron los patrones en los cuatro cuadrantes de la región glútea. Se encontraron 3 a 12 ramos nerviosos extramusculares de los músculos glúteo máximo, medio y mínimo. Después de ingresar al músculo, estas ramas nerviosas se arborizaron y anastomizaron para formar una zona densamente nerviosa en forma de arco. La distribución nerviosa fue de mayor densidad en la región inferomedial del cuadrante superolateral y en la región inferolateral del cuadrante superomedial de la región glútea. La distribución nerviosa era relativamente densa en la región inferolateral del cuadrante superolateral y en la región medial del cuadrante inferomedial. Una zona en forma de arco en los cuadrantes superolateral y superomedial y con escasa inervación, cerca de la cresta ilíaca representaba una parte de los límites de los dos cuadrantes. La zona de poca inervación en forma de arco en el cuadrante superolateral es el sitio de inyección preferido, y el cuadrante superomedial próximo a la cresta ilíaca también se recomienda como una región de inyección intramuscular glútea, libre de lesión nerviosa.

Massage effect on transforming growth factor betal signaling pathway in a rabbit model of gluteal muscle contracture / 中国组织工程研究

BACKGROUND: Recent studies have shown that TCM massage can alleviate or even reverse the progression of muscle fibrosis, so it is speculated that massage can also improve the pathological changes of gluteal muscle contracture. OBJECTIVE: To evaluate the role of massage on gluteal muscle contracture and the relevant mechanism. METHODS: Twenty young rabbits were divided into an experimental group and a control group, with penicillin and benzyl alcohol injection for 8 weeks respectively. Besides, the experimental group received massage therapies for 4 weeks, whereas the control group had no specific intervention. Cell morphology and structure were observed using hematoxylin and eosin staining, Masson staining and Sirius red staining. Expression of transforming growth factor-pi in the rabbit model of gluteal muscle contraction was measured using immunohistochemistry, reverse transcription PCR and western blot assays. The study protocol was approved by the Ethics Committee of Peking University Shenzhen Hospital in China. RESULTS AND CONCLUSION: The experimental group had significantly less hyperplasia of fiber tissue compared with the control group (F < 0.05). The expression levels of collagen type I and transforming growth factor-31 were significantly increased in the control group compared with the experimental group, as determined by reverse transcription PCR, western blot assay and immunohistochemical staining (P < 0.05). Therefore, massage therapy can alleviate the progression of gluteal fibrosis, which is expected to provide a new idea for the research and treatment of gluteal muscle contracture.

Comparative study of different clinical approaches for gluteal muscle syndrome with silver needle / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of silver needle lumbar and sacral spine approach in treating gluteal muscle syndrome.@*METHODS@#Eighty-seven patients with gluteal muscle syndrome treated with silver needles in the Department of Rehabilitation Medicine of our hospital from September 2017 to September 2019 were selected. Except for symptoms of waist and hip pain and discomfort, all selected patients were examined by CT or MRI to confirm pathological imaging changes such as inflammatory exudation of the gluteal muscle. The 87 patients with gluteal muscle syndrome were divided into 2 groups according to the digital table method, and 42 patients in the lumbosacral approach group, including 19 males and 23 females, aged (50.70±12.45) years old, and disease duration of (1.63±1.27) years;45 cases in the buttock approach group, including 20 males and 25 females, aged (52.80±12.18) years old, with a course of disease of (1.78±1.22) years. The lumbosacral approach group was treated with spinal L to S bilateral articular process joints and L transverse process acupuncture needles, and the buttock approach group was treated with the gluteus medulla wing starting point and femoral trochanter stop. The VAS scores, soft tissue tenderness thresholds, and hip abductor muscle strength of the affected group were measured before and 4 weeks after treatment in the two groups. The clinical efficacy was also evaluated 4 weeks after treatment.@*RESULTS@#After 4 weeks, the VAS score of the lumbosacral approach group was 1.26±0.70, and the buttock approach group was 1.18±0.74, which were significantly lower than those before treatment, but there was no statistical difference between the groups (>0.05). The soft tissue tenderness threshold and ipsilateral hip abductor muscle strength were (5.51±0.70) kg and (10.34±2.19) kg in the lumbosacral approach group, and (4.78±1.05) kg, (9.33±1.42) kg in the buttock approach group. The results in the lumbosacral approach group was better than those in the buttock approach group(<0.05). The clinical efficacy of the lumbosacral approach group:16 cases got an excellent result, 20 good, 5 fair and 1 poor;in the buttock approach group, 13 excellent, 17 good, 12 fair and 3 poor. The clinical efficacy between the two groups had statistical difference (<0.05).@*CONCLUSION@#In the treatment of gluteus medius syndrome with silver needle, lumbosacral approach and buttock approach can effectively relieve the pain. Compared with the improvement of soft tissue tenderness threshold and hip abductor muscle strength, the upper lumbosacral approach is more prominent, and the overall clinical effect is more significant.

Expression and effect of TGF-β1 and HSP47 on gluteal muscle contracture / 西安交通大学学报(医学版)

Objective To explore the expression and effect of transforming growth factors-β1 (TGF-β1) and heat shock protein (HSP47) on gluteal muscle contracture (GMC). Methods We collected contraction band and adjacent muscle from GMC patients and explored the expression of TGF-β1 and HSP47 using immunohistohemistry, reverse transcription and polymerase chain reaction (RT-PCR), and Western blot analysis. Results TGF-β1 and HSP47 were intensely expressed in fibroblast cells and vascular endothelial cells. The expression of them increased 8.1-fold and 3.6-fold at the mRNA level, respectively (P<0.05). The same changes were found at the protein level, which increased 11.2-fold and 7.6-fold, respectively (P<0.05). Conclusion Up-regulation of TGF-β1 and HSP47 may initiate fibrotic cascade in the gluteal muscles of GMC patients.

Lumbar Pyogenic Spondylodiscitis and Bilateral Psoas Abscesses Extending to the Gluteal Muscles and Intrapelvic Area Treated with CT-guided Percutaneous Drainage: A Case Report

Bilateral psoas abscesses extending to the gluteal muscle and intrapelvic area are uncommon. We present our experience with computed tomography (CT)-guided percutaneous catheter drainage for the treatment of multiple aggressive abscesses in a diabetic patient. The abscesses completely resolved after the procedures. Psoas abscess should be considered in the differential diagnosis of older diabetic patients with fever, flank or back pain, and flexion contracture of the hip joint. CT scanning is a useful method in diagnosing abscesses, and CT-guided percutaneous catheter drainage is an effective treatment method in selected patients.

Treatment of Severe Gluteal Muscle Contracture in Children / 华中科技大学学报（医学）（英德文版）

To investigate the efficacy of a combination therapy on gluteal muscle contracture, 286 definitely diagnosed patients were subjected to surgical treatment, and then functional exercises and physical therapy. The patients with severe symptoms were asked to have a set of specially-designed functional exercises. All the patients were followed up for 3 to 24 months by hospital visit, correspondenee or telephone interview. The effective rate was 100%, and the curative rate was up to 94.6%. Few patients developed complications and relapse was rare. It is concluded that the combination therapy, including surgical removal of diseased tissues, functional exercises and physical therapy, is an effective approach for the treatment of severe juvenile gluteal muscle contracture.

Comparison of the therapeutic effects of arthroscopic treatment and conventional therapy for gluteal muscle contracture / 中国矫形外科杂志

[Objective]To compare the immediate therapeutic effects of the treatment of gluteal muscle constracture(GMC)with arthroscopic release of contractured tissue and conventional surgery.To investigate the indications of arthroscopic surgery.[Method]Ninty-six limbs of 48 patients with traditional surgery and 84 limbs of 42 patients with arthroscopic surgery were analyzed in terms of operation time,length of the incision,postoperative pain,complications,the time of exercise,postoperative hospital stay and one-year recurrence rate.[Result]Arthroscopic surgery group had smaller incisions,earlier exercise,less postoperative pain and shorter hospital stay than conventional surgery group,but the two groups showed no significant difference in operative time,complications,effects of operation and one-year recurrence rate.[Conclusion]Arthroscopic release of contracture tissue is a safe,effective,economical and cosmetic way to treat the gluteal muscle contracture.This method is worthy of wide promotion.

Effect of early off-bed to arthroscopically assisted radiofrequency release of gluteal muscle contracture / 中国矫形外科杂志

[Objective]To evaluate the feasibility of early off-bed exercises after arthroscopically assisted radiofrequency release of gluteal muscle contracture.[Method]Patients of gluteal muscle contracture underwent arthroscopically assisted radiofrequency release of gluteal muscle contracture.Post-operative off-bed time,side effects,duration of urinary catheter drainage,wound healing,early recovery of function,and in-hospital time were studied.[Result]Off-bed time averaged 7 hours(6~8 hours).Two cases complained of being faint and nausea.After allopathic treatment,no serious complications appeared.Averaged duration of urinary catheter drainage was 7.5 hours.Primary healing of wounds were found in 67 patients,while 1 case got delayed wound healing.None of them had any infections.Functional scores averaged 9 at the time of discharging and 10 after 1 month.Post-operative in-hospital time averaged 2.58 days(2~6 days).[Conclusion]Arthroscopically assisted radiofrequency release of gluteal muscle contracture results in early post-operative off-bed time and reduction of suffering,which is propitious to functional recovery,rate of healing,and shorter in-hospital time.

The Method and Evaluation of Measurement of Hip Joint in the Gluteal Muscle Contracture in Children / 实用放射学杂志

Objective To evaluate the effect on the development of hip joint by gluteal muscle contracture and to study the significance of early surgical treatment for this disease.Methods X-ray films of pelvis in 102 cases with gluteal muscle contracture were taken before surgical treatment.The acetabular index,the neck-shaft angle and the acetabular-head index(AHI) were measured.Results The neck shaft angle(x=149.64) and the CE angle(x=34.12) were increased,the acetabular-head index(x=72.3%) was decreased,and the acetabulainr index(x=13.6) was normal.Conclusion The gluteal muscle contracture can causes coxa valga and subluxation of the hip joint,early surgical treatment is needed.

Clinical Study of the Immunologic Factors in the Pathogenesis of Gluteal Muscle Contracture / 昆明医科大学学报

Objective To study the immunological pathogenesis of gluteal muscle contracture. Methods In 43 children with gluteal muscle contracture and 22 normal control cases, peripheral blood T-lymphocytes, B-lymphocyte and its subset were analyzed with flow cytometry. Results The percent of CD4+, B-lymphocyte and CD4+/CD8+ in children with gluteal muscle contracture were all significantly higher than those in the control(P0.05). Conclusion There is disorder of immunological regulation in children with gluteal muscle contracture. Immunologic factors may play an important role in the pathogenesis of gluteal muscle contracture.

Gluteal Fibrosis in Adult / 대한정형외과학회잡지

Gluteal fibrosis is rare in Kores. We thought the probable primary etiology of gluteal fibrosis might be repeated intramuscular injection into the buttock, Inability to adduct the legs in the sitting position and flex the hips in neutral position had been observed. Four cases(3 persons) of gluteal fibrosis in adult from October 1986 to February 1987 are presented with much improvement of squatting and flexion of hip in neutral position after operation.