After gluteal muscle contracture operation, walking knee hurts and is awkward. What happened?

Injection factors Most scholars believe that the disease is related to repeated injections of buttocks, and the local formation of a mass after intramuscular injection is the performance of myofibrositis. Lloycl-Roberts and Thomas suggested that in the pathological examination of children with intramuscular injection, there were edema and bleeding at the injection site, which might lead to fibrosis, and then scar contraction led to contracture. In 1968, Williama reported that there was an inflammatory reaction at the injection site of antibiotics in animal experiments. Penicillin diluted by intramuscular injection of 2% benzyl alcohol has the largest reaction, which leads to degeneration and necrosis, leading to fibrosis. Children's susceptibility factors, immune factors. A large number of children received intramuscular injections, but only a few got sick. It was found that children with gluteal muscle contracture had immune regulation disorder, and TS cells were obviously low, which led to the relative hyperactivity of th cells. After receiving benzyl alcohol injection, the immune response caused by drug hapten can not be terminated in time, which is easy to cause immune damage. At the same time, the increase of serum IgG and the decrease of C3 were observed, which provided indirect evidence.

Human erythrocyte membrane has a receptor, which is a glycoprotein. Red blood cells can recognize and capture immune complexes in vivo through the adhesion of receptors on their membranes. 95% of the receptors in circulating blood are located on the erythrocyte membrane, so the main cell for people to remove immune complexes is red blood cells. The results showed that the activity of erythrocyte receptor and the level of erythrocyte membrane immune complex in children with gluteal muscle contracture were significantly lower than those in normal people, suggesting that the erythrocyte immune function of children was low and they could not adhere to and remove the immune complex produced after drug injection in time and effectively.

Connecting section method showed that there was immune complex deposition in the wall of small blood vessels of contracture gluteus muscle. Immune complex will damage the blood vessel wall, cause blood coagulation in the blood vessel and lead to tissue hypoxia, and then muscle cells will be damaged and fibroblasts will be activated, which will eventually lead to gluteal muscle fibrosis.

scar constitution

Genetic factors.

It has been reported abroad that 1 child has bilateral deltoid contracture and gluteal contracture, and his mother also has bilateral deltoid contracture, which can not be explained by intramuscular injection alone, and can be considered to be related to heredity. Postoperative complications of congenital dislocation of hip caused by trauma and infection. Several cases of bilateral congenital dislocation of hip joint have been reported in China. Gluteal muscle contracture was found 3 ~ 4 months after Salter osteotomy.

Sequela of gluteal myofascial compartment syndrome

Hip infection

Visual examination of pathological changes showed that there were depressions, lumps or fascia in the buttocks of the child. During the operation, the red muscle fiber can be replaced by gray-white fiber tissue, especially on the greater trochanter of femur. Fascia contracture thickens, penetrates into some muscle fibers of gluteus maximus and gluteus medius, and is grayish yellow, which can be mixed with normal muscle fibers. In severe cases, there are few normal muscle fibers. There is a fibrous contracture zone on the upper part of gluteus maximus, which is inconsistent in width, generally 2 ~ 7 cm, involving the whole layer of gluteus maximus, pale and inelastic, and is tendon-like tissue. Microscopically, most contracture gluteal muscles showed muscle cell atrophy, mostly local or peripheral, and the closer to the fibrotic site, the more obvious the atrophy. The striations of muscle cells disappeared, the nucleus shrank and dissolved, and some of them formed homogeneous and unstructured substances. The fiber spacing between muscle cells and muscle bundles increases, forming fiber bundles, in which many fibroblasts can be seen. The number of intermuscular blood vessels decreased, the wall of the tube became thicker, the lumen was small and irregular, partially occluded, and neutrophils and lymphocytes infiltrated around the tube.

Clinical classification Different clinical manifestations are divided into:

① lump type: the buttocks can reach a knotted lump;

② Membrane type: flaky contracture of gluteal muscle fascia;

③ Band type: gluteal myofascial contracture. The muscles involved can be divided into:

① Simple gluteus maximus contracture type;

② Simple gluteus medius contracture;

③ Complex contracture of gluteus maximus and gluteus medius (including gluteus minimus contracture).

The clinical manifestations of this disease are often bilateral and unilateral, and it is reported that there are more men than women. Hip adduction and internal rotation limitation in patients with hip joint dysfunction. When standing, the lower limbs rotate outward and cannot be completely close together. Walking often has an outer eight, a swinging gait and a quick jump. When you sit down, your legs can't be together, your hips are separated in a frog posture, and it is difficult for one thigh to lean on the other (cross-legged test). When squatting, the knees of the light person are separated first, and then they are together after squatting (circle sign). In severe cases, you can only squat in abduction and supination. When squatting, the hips are in abduction and rotation position, the knees can't be together, and the heels don't touch the ground, showing a frog style.

Physical examination found that there was a skin depression in the upper part of the buttocks, which was more obvious when the buttocks were adducted, and the buttocks could feel tight. The lower limbs are in abduction and external rotation, and the adduction and internal rotation of hip joint are limited. The flexion of hip joint in neutral position of lower limbs is limited, and the affected hip must be abduction and external rotation, so that the affected hip can be fully flexed back to the original sagittal plane after being pulled out for half a turn. Bouncing sensation of greater trochanter of femur. Ober sign positive. If the pelvis is severely deformed, the acetabular floor may protrude into the pelvis, forming Otto's pelvis. Children with gluteal muscle contracture have greater trochanter epiphysis. Children with bilateral asymmetric gluteal muscle contracture may have pelvic tilt and secondary lumbar scoliosis. The anterior superior iliac spine on the severe side is lower than that on the mild side, and the distance from the umbilicus to the ankle on the severe side is longer than that on the mild side, while the distance from the greater trochanter to the ankle on both sides is equal. X-ray findings of auxiliary examinations are often reported as normal. The X-ray study of children with contracture by Fang Lunguang and Han Jingming found that CE angle increased (X=36.62), neck shaft angle increased (X= 153) and femoral head index decreased (X=0.44). Early operation is helpful to the recovery of the above secondary changes during postoperative follow-up. Preoperative CT cross-sectional scan of gluteus contracture showed that the density of inflammatory lesions decreased in the early stage, and many groups of muscle bundles accumulated with the development of the disease in the later stage. Muscle fibers are replaced by connective tissue, which shows that the muscle volume decreases, the density increases, the myofascial space widens, and finally the scar forms a rope shadow. Scanning can determine the location, scope and severity of lesions and provide valuable clinical data.

Grading of gluteal muscle contracture Fernandez grading method According to the external hip flexion contracture angle of 90 minutes: mild: 30. Songjiang Branch of the 455th Hospital of China People's Liberation Army used the following criteria to grade gluteal muscle contracture.

Previous medical history: multiple gluteal muscle injections 1 min.

Symptoms: abnormal gait (figure-eight, swinging gait) 1 min.

Don't cross your legs 1 min

Knees together, squat limit 1 min.

Signs: limited hip flexion or 90 hip flexion, with knees separated by 65438 0 points.

Ober symbol plus 1 dot

Knee circle sign or hip bounce 1.

Pelvic malformation or limb false unequal length 1 min

X-ray film: acetabular index decreased 1 min.

The femoral neck shaft angle increased by 65438 0 points.

According to the score, gluteal muscle contracture was graded: mild: 3 ~ 4 points; Moderate: 5 ~ 7 points; Severity: 8 ~ 10.

The muscle fibers of gluteus maximus are inclined downward from inside to outside. The fibers in the upper half extend into the iliotibial tract, and the fibers in the lower half also extend into the iliotibial tract. The deep fiber stops at the thick line of musculoskeletal gluteal muscle, and its proximal edge is connected with iliotibial tract. There is a gap parallel to the longitudinal axis of femur, which can be used as a sign of loosening. It can be exposed only by cutting the proximal edge of gluteus maximus and the junction of iliotibial tract, and the sciatic nerve is under its deep medial fascia. It is safe and simple to free gluteus maximus on its surface. Surgical methods can be simply divided into the following categories:

① Excision of gluteal muscle contracture zone: This operation is traumatic, bleeding, easy to damage sciatic nerve, leaving a cavity after operation, and the release is not complete, especially in severe cases, the gluteal muscle contracture zone is large, for fear of damaging sciatic nerve, and the medial contracture zone is not completely removed, which affects the curative effect. So it has been used less now.

② Gluteal contracture band amputation: The operation is simple and minimally invasive. In severe cases, the curative effect is often not ideal because the tension part of gluteus maximus tendon plate can not be released.

③ Gluteal contracture band cutting and gluteus maximus release: Arthroscopic double incision operation can expose the posterior margin of fascia lata, the lower margin of gluteus maximus contracture band and the lower part of gluteus maximus tendon plate, with small incision and little trauma, which can fully solve the pathogenic factors in the operation field and achieve satisfactory results. Surgical treatment: taking arthroscopic release as an example, this paper introduces the surgical treatment of gluteal muscle contracture;

① Disinfection sheet: The patient lies on his side, and the disinfection sheet is made with reference to bilateral hip joint surgery. After laying the sheets, the patient should be able to turn left and right, flex and extend the hip joint on the operating table without polluting the operating field.

② Anesthesia: ketamine basic anesthesia or combined spinal-epidural anesthesia.

③ Surgical release: The patient lies on his side, with the surgical side facing upward, and the affected hip joint retracts in a straight position, which makes the fibrous cord tense. In most cases, there are fibers in the upper gluteus muscle, iliotibial tract on the surface of gluteus medius muscle and gluteus myofascial contracture in front of tensor fascia lata, which are the main release sites of the disease. On the back of the big rotor 1 cm, make a 0.4cm incision with 3 cm, and the stripper creates the operation space. Microscopically, denatured fibrous tissue with deep contracture and thickening can be exposed. The iliotibial tract was cut on the surface of gluteus medius muscle and returned to the edge of gluteus maximus, so that the space between gluteus maximus and iliotibial tract behind the greater trochanter of femur was clearly exposed, and the contracture tissues were released one by one with a radio frequency cutter. Release tensor fascia lata and its superficial gluteal fascia forward as needed. At this point, most situations can be completely liberalized. Be careful about gluteal muscle contracture. If there is partial septal contracture in muscle fibers, contracture fibrotomy is feasible. In most cases of fibrous contracture, lengthening surgery should be performed to preserve hip abduction function, keep hip joint stable and avoid flexion gait.

④ Relaxation degree: The range of motion achieved: the adduction and pronation positions were about 10 respectively, and the hip joint flexed from the straight position to more than 120. Or check that the flexion of the hip joint is 90 and the adduction of the hip joint is greater than 30 when Ober sign is checked; Hip adduction in hip extension position is greater than 10, and hip flexion test can end the operation without bouncing in extreme adduction and internal rotation position.

⑤ Postoperative treatment: radiofrequency was used to stop bleeding completely, and silicone tube was used to drain deep contracture when necessary, and subcutaneous tissue and skin were not sutured. After operation, the local gauze pad was pressed and fixed for 24 ~ 48 hours. Extubation was performed 48 hours after operation.

Non-surgical treatment

Treatment of gluteal muscle contracture with minimally invasive needle knife

Small needle knife consists of needle handle, needle body and needle blade. It is a new medical instrument which combines acupuncture needle of traditional Chinese medicine and scalpel of western medicine, and they complement each other. It looks like a needle with a blade at the end, turning open surgery into closed surgery. Needle knife to relieve gluteal muscle contracture, generally 2-4 pinholes, 0.2 mm, not easy to be infected, leaving no scars.

Needle knife can release tissue adhesion, eliminate induration, relieve tissue pressure, improve blood circulation, promote inflammation regression, accelerate edema absorption and relieve vascular nerve entrapment. The contracture of gluteal muscles (including superficial muscles, middle muscles and deep muscles) was released as a whole, and the joint capsule contracture was serious. Needle knife can seal and cut off contracture zone (contracture muscle) and contracture joint capsule.

The formation of local hematoma after operation is related to incomplete hemostasis during operation and poor drainage after operation. Local swelling after hematoma formation, persistent pain, easy to cause infection; Hematoma compression can cause skin ischemia and necrosis at the edge of incision. Therefore, the bleeding should be stopped completely during the operation, and rotational drainage and local pressure dressing should be carried out after the operation. Use necessary hemostatic drugs after operation. If hematoma is found, treat it as soon as possible. Infection is related to improper handling of aseptic principle during operation and hematoma formation after operation. Incomplete remission or recurrence of symptoms is related to incomplete release or soft tissue tension. Recurrence may be related to incomplete amputation of contracture tissue and relative shortening with development, or to delayed functional exercise and scar re-adhesion after operation. Although the skin edge of incision scar is well matched during operation, most children have large scar at the incision after operation. Considering its scar constitution. Therefore, some people think that scar constitution should be regarded as a manifestation of gluteal muscle contracture syndrome. Patients with myasthenia gravis in gluteus can have a swinging gait after operation. With the passage of postoperative time, the scar tissue connects the broken ends of the gluteus medius muscle, and the gluteus medius muscle weakness will eventually disappear. Intraoperative arterial bleeding is rare, but special attention should be paid to it. When releasing the fascia of gluteus maximus under the greater trochanter, it is easy to encounter small branches from the inferior gluteal artery, which can be avoided by careful separation or ligation. Accidental cuts should be reliably sutured to stop bleeding.

After contracture is released, functional exercise is introduced after operation, which can recur due to gluteal muscle re-adhesion. Therefore, active exercise and functional exercise should be taken after operation to overcome snap sign and frog leg sign, prolong residual contracture tissue, improve the obstacle of limb unequal length, and prevent the broken end of iliotibial tract of tensor fascia lata from re-adhesion.

It is very important to consolidate the release effect. Six hours after operation, good limb posture: take off the pillow and lie flat, wrap your knees together with bandages, put a soft pillow under your knees, bend your hips 60 degrees and knees 30 degrees, and fix them for 24 hours. Observe the bleeding of the wound. If there is little bleeding or drainage, pull out the drainage tube and start functional exercise.

Within 24 ~ 48 hours after operation, assist and guide the patient to cross his lower limbs in bed, flex and adducte his hip joints, and practice sitting up, three times a day, 30 minutes/time.

48 hours after operation, help the child get out of bed and walk, one step at a time: hold out his chest, lift his shoulders horizontally, walk in a straight line and cross his lower limbs. Three times a day, 30 minutes each time.

3 ~ 4 days after operation, on the basis of gradual walking, hip abduction and squat exercises were gradually increased: feet together, hands raised horizontally,

Heels should not leave the ground, and the back should be straight. 3 times/day, repeat exercise 200 times.

On the 7th day after operation, on the basis of correcting abnormal gait, leg exercises were performed (crossing your legs). When crossing your legs, you sit in an armchair, your back is close to the backrest, one leg straddles your knee, crosses the other leg, and your left and right legs cross, and you actively stretch by swinging your hips left and right. Three times a day, 30 minutes each time. The above-mentioned functional exercises should be carried out step by step to prevent the bleeding incision from cracking due to excessive activity. On the basis of consolidating the above-mentioned functional exercises, the guidance before discharge is to do knee joint functional exercises after discharge. These methods are as follows:

① Sit, bend your hips and knees, then spread your hips outward to the maximum, and put your feet together in front of you. Press your hands on the inside of the knee joint and try to recover your legs together. Repeat 5 times.

② In supine position, the hip and knee of one affected limb flexed, then fell inward to the maximum position, and then fell outward to the maximum position and reset. Repeat 5 times alternately left and right.

③ Standing posture, feet are separated back and forth, the front knee joint is flexed, the rear knee joint is straightened, hands are pressed against the front knee joint, and the body slowly leans forward for 5 seconds. Restore. Repeat 5 times alternately from left to right, and insist on doing it for 6 ~ 2 months after discharge. Squatting and sitting up freely are the standards of self-care.

Evaluation of curative effect The effect of the operation is not only related to the age and condition, but also closely related to the thorough release. The following indicators can be used to judge the curative effect:

Nursing care of patients with gluteal muscle contracture. Gluteal muscle contracture mostly occurs in children, mainly due to gluteal muscle fiber contracture caused by long-term repeated drug injection, which leads to abnormal hip function. Surgery to completely release and remove contracture tissue is the most effective treatment. Due to the large wound and more bleeding, it is necessary to closely observe the bleeding of the wound after operation. In addition, correct posture and proper functional exercise after operation are also important measures to improve the function of hip joint. Common nursing problems include: ① fear; ② Self-care defects; 3 pain; ④ Bedsore may occur; (5) Potential complications-more bleeding in the wound; ⑥ Lack of knowledge: Exercise knowledge in special posture and function.

First, fear

Second, self-care defects

Third, pain.

All the above 1 ~ 3 refer to the relevant contents in the General Standard Nursing Plan for Orthopedic Patients.

Fourth, there is the possibility of bedsore.

Related factors:

1 The operation wound is large, and the local blood circulation of buttocks is affected.

2 local compression.

The main manifestations: the skin of sacrococcygeal and costal arch turns red, dark and even necrotic.

Nursing goal: The patient has no bedsore.

Nursing measures:

Four hours after the operation, the position was changed from supine position to prone position. The prone position time depends on the patient's tolerance and incision bleeding: if the patient has strong tolerance and less wound bleeding, the prone position time will be long; On the contrary, it shortens the prone position time. Generally, the supine position is changed to prone position after 2-3 hours.

2 when lying prone, put a pillow on your chest to prevent pressure sores at the rib arch.

3 strictly shift within 24 hours after operation. Once the sacrococcygeal part turns red and dark, immediately prone position, try to avoid supine position or reduce supine position time, in order to reduce local oppression and reduce skin damage.

Key assessment: Does the patient have sacrococcygeal bedsore and rib arch bedsore?

The potential complication is that the wound oozes more blood.

Related factors: the surgical wound is large, and the contracture tissue needs to be completely released and removed.

Main performance:

1 The wound has more bloody drainage.

The wound dressing was wet with blood.

In severe cases, the pulse is accelerated, breathing is accelerated, and blood pressure drops.

Nursing objectives:

Nursing measures:

Key evaluation: All the above items refer to the relevant contents in the Standard Nursing Plan for Patients with Congenital Dislocation of Hip.

6. Lack of knowledge: special posture and functional exercise knowledge.

Related factors:

1 No professional knowledge education.

Fear of exercise because of pain.

Main performance:

1 Special positions cannot be maintained.

2 I don't know the methods and procedures of functional exercise.

3 refuse to do functional exercise.

Nursing objectives:

1 Children's families understand the significance of special posture and functional exercise, and cooperate with them to maintain special posture and carry out functional exercise.

Children can cooperate with special postures and functional exercises.

3 children's posture is correct, and functional exercise can be carried out step by step.

Nursing measures:

1 Explain to children and their families the significance of adopting special posture and functional exercise to improve hip joint function, and guide them to cooperate to maintain special posture and adhere to functional exercise.

Bind the knees together with bandages after operation, so that the lower limbs can be adducted.

3. Cushion the lower limbs with a pillow every day, so that the hip joint and knee joint are in flexion position to relieve the pain.

4 Three days after operation:

(1) If the pain is relieved, release the restraint of the pillow and knees, and encourage the child to sit up, straighten his lower limbs and put his knees together.

(2) If the wound does not continue to bleed and hematoma, it can help the child to walk on the ground and avoid abduction and rotation gait of the lower branch.

(3) Method of passive training in bed: ① The child lies flat on the bed and gradually flexes the knee joint and hip joint, so that the bent lower limbs are close to the abdomen. (2) The nurse holds the child's head and neck with one hand, and presses the flexion knee joint with the other hand, so that the child changes from a lying position to a squatting position and squats on the bed.

(4) After a few days of passive training, start active exercise. The methods are as follows: ① When the child falls to the ground, the nurse holds his hands to make him squat. (2) The child squatted down with the bed railing. (3) When squatting, keep your feet on the ground and tuck your knees in your hands. ④ Observe the principle of gradual progress when exercising. When the wound is bleeding due to excessive force, you should stop exercising and stay in bed to avoid increasing the chance of incision infection and delaying healing.

(5) Because children are more afraid of pain than adults and lack endurance, we should encourage them to make progress every time and enhance their confidence.

It is feasible to practice "crossing your legs" after 5 2 weeks of stitches removal, and children who still have difficulty in sports can be treated with physical therapy. General exercise 1-2 months can return to normal.

Critical assessment

1 Whether children and their families can cooperate in taking therapeutic posture and functional exercise.

2. The degree of improvement of hip function after operation.

At present, the etiology of GMC is not completely clear, and it is mostly considered to be related to repeated intramuscular injection of buttocks. Most cases reported in the literature are caused by injection, and GMC has no exact classification method. We believe that GMC is a group of clinical symptoms caused by many reasons, with hip dysfunction as the main manifestation. Classification according to the etiology and pathological degree is helpful to better understand and guide the treatment of GMC. A large number of documents at home and abroad reported GMC for injection, mostly in countries and regions with gluteal muscle injection habits, and pointed out that benzyl alcohol is the most dangerous pathogenic factor [4]. This group of cases shows that the younger the onset age of intramuscular injection, the higher the incidence rate (the average onset age is 2.7 years old), indicating that the immune function and anatomical characteristics of infants are directly related to the occurrence of GMC. It is particularly noteworthy that among the 6 patients (8.5%) with sciatic nerve injury in this group, 5 cases were misdiagnosed as GMC, 1 were misdiagnosed as "polio" for a long time, suggesting that there is a close relationship between them. Nerve release and contracture zone release should be carried out simultaneously as soon as possible. We realize that most patients injected with GMC can get good results by partially removing and releasing the contracture zone. In most cases, it is not necessary to expose the sciatic nerve, but the lesions are extensive, especially in patients with small external rotation muscle group or contracture of hip joint capsule. In order to prevent nerve injury, the sciatic nerve should be exposed first. In patients with gluteal muscle contracture, it is estimated that it is difficult to release the gluteal muscle, and the iliac crest can be cut and the gluteal muscle can be peeled off from the external iliac plate. Its advantage is that it can not only obtain good surgical effect, but also prevent the accidental injury of sciatic nerve and hip joint stretching weakness after the contracture zone is widely relaxed. The etiology of idiopathic GMC is unknown, and there is no history of intramuscular injection, trauma, other muscle contracture and family history before the onset. The onset age varies, but it can be after 3 years old or in adolescence. After the onset, the symptoms gradually aggravated, mostly symmetrical bilateral lesions, and the lesions were mild. Most of them were located in gluteus maximus and moved down to iliotibial tract, showing flaky contracture, and gluteal muscle degeneration was mild, mainly fascia degeneration and thickening. Surgical resection of the flaky contracture zone can achieve satisfactory results. GMC after congenital dislocation of hip joint mostly occurs in older children with high dislocation of femoral head who receive open reduction and pelvic osteotomy, and the incidence rate is 0.4%[5]. Because of the wide range of surgery, serious tissue damage and easy fibrosis; The femoral head with high dislocation was restored to the primary acetabulum, and the rotation of pelvic osteotomy was prolonged. When the iliac crest periosteum is sutured under tension, the gluteus muscle is relatively prolonged and the muscle tension is obviously increased. In addition, long-term plaster fixation after operation may aggravate muscle tension and ischemia and cause fibrosis. Secondly, too tight suture of hip joint capsule can also cause abduction contracture deformity. Some authors believe that the symptoms of GMC in some patients are slightly ignored before operation, and the symptoms are obvious after pelvic lengthening [6]. Preventive measures include adequate traction before operation, not too tight suture of hip joint capsule during operation, and not in-situ suture due to excessive tension of iliac crest periosteum. Because the formation of GMC is mainly related to the increase of gluteal muscle tension and fibrous scar after operation, we realize that iliac crest incision and gluteal muscle downward movement are more suitable for this kind of patients. Osteofascial compartment syndrome of hip joint is rare [7], which mostly occurs unilaterally. The main reason is the trauma caused by long-term hip compression or fixed posture after loss of consciousness. The former is often neglected because of systemic complications, which delays the diagnosis. Because of the severe pain, the latter can avoid this complication if it can be cut and decompressed in time. Its pathological mechanism is the same as that of osteofascial compartment syndrome of limbs, which eventually leads to ischemic necrosis and contracture of gluteal muscle in fascial compartment. However, because the sciatic nerve does not directly pass through the gluteal fascia room, there is no nerve injury or the symptoms are mild. GMC can be avoided by timely incision and decompression to preserve viable muscle tissue. After operation, the affected hip should be placed in the position of adduction and flexion, and early functional exercise should be carried out. GMC symptoms should be relieved by surgery. Infectious GMC has a history of hip soft tissue infection, and skin scars formed by drainage or abscess sinus can be seen in hip and infected area. Deep and extensive infection of hip soft tissue can spread to thighs, causing quadriceps contracture. Fibrous scar tissue formed by gluteal muscle fascia and fascia lata infection and muscle necrosis is extensive, tough and contracture. Timely treatment of hip infection, prevention of infection spread and control of early functional exercise after infection are all helpful to prevent GMC. The contracture release should be carried out more than 3 months after the infection is completely controlled. If it is combined with quadriceps contracture, it should be treated together. Some cases are local manifestations of multiple myofascial contracture, and the symptoms of contracture gradually worsen, and GMC symptoms appear when the lesion invades gluteal myofascia. Surgical treatment only improves local joint function, has no effect on the natural progress of the disease, and has a high disability rate. It has been reported that some GMCs have genetic tendency and may have a family history. It is considered that they may be congenital diseases inherited in different ways under the influence of some environmental factors [8]. In addition, the most common soft tissue tumor in children's buttocks is desmoid tumor, which is easily overlooked because most tumors are painless or painless. Because the tumor invades gluteal muscle and its fascia, it leads to dysfunction, and it is more common because of the clinical manifestations of GMC. Therefore, children with unilateral GMC should be highly vigilant. Abundant buttocks without pointed buttocks, touching the mass and infiltrating the gluteal muscle fascia are the main differential points. Early diagnosis and extensive and complete resection of tumor and its affected tissues, including surrounding healthy tissues, are the key to successful operation. The author [9] has also reported that the abnormal connection of femoral neck with 25 inclination angle caused by intertrochanteric fracture is similar to gluteus maximus contracture. Knees can't be together when squatting, and the affected hip can only squat at least 30 degrees. When the femoral neck anteversion was corrected to10 by osteotomy, the symptoms and signs of GMC disappeared.