Minimally invasive treatment of grade I and II gluteal muscle contracture using a self-made special cutter combined with a specialized compression hemostasis device

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Methods The data of 88 patients with GMC treated in our hospital from May 2017 to January 2021 were analyzed retrospectively. They were divided into two groups according to different surgical instruments and hemostatic devices. There were 44 cases in the minimally invasive group, including 18 males and 26 females whose age ranged from 7 to 25 years with the course of disease ranging from 3 to 21 years. There were 27 cases of grade Ⅰ and 17 cases of grade Ⅱ who were treated with self-made special cutter for GMC combined with self-made special compression hemostasis device. While there were 44 cases in the traditional group, including 17 males and 27 females whose age ranged from 6 to 23 years with the course of disease ranging from 4 to 20 years. 25 cases of grade Ⅰ and 19 cases of grade Ⅱ in this group used open gluteal contracture fasciolysis combined with traditional abdominal band compression to stop bleeding. The incision length, operation time, intraoperative bleeding and postoperative bleeding were compared between the two groups. Results There were no complications such as infection, hip instability and sciatic nerve injury in the two groups. The cross-leg test, knee squat, gait and movement returned to normal. Ad Ober's symptom and frog leg symptom were negative. One patient in the traditional group had secondary hematoma after incision, which was cured by incision and drainage again. The incision length (1.3 ± 0.2 cm) in the minimally invasive group was significantly shorter than that in the traditional group (6.4 ± 1.4 cm), as was the operation time (46.3 ± 7.9 min vs 62.2 ± 15.1 min). Meanwhile, the amount of intraoperative bleeding (33.7 ± 11.5 ml vs 60.9 ± 25.0) ml) and postoperative bleeding (51.1 ± 19.4 vs 112.9 ± 36.2ml) of patients in the minimally invasive group was significantly lower than that in the traditional group, respectively (P < 0.05). Conclusion The minimally invasive treatment of grade I and grade II GMC with a self-made special cutter combined with a special compression hemostatic device can achieve favorable clinical outcomes. Additionally, it causes less trauma, simplifies the operation, reduces intraoperative and postoperative bleeding, allows for early functional exercise, and promotes rapid functional recovery. Therefore, this treatment is worthy of clinical application. Minimally invasive gluteal muscle contracture cutter oppression Figures Figure 1 Figure 2 Figure 3 Background In recent years, surgical treatment of gluteal muscle contracture (GMC) has become a research hotspot[ 1 – 3 ]. However, open surgery has complications such as severe trauma, more bleeding, obvious influence on postoperative muscle strength, slow functional recovery, and surgical scar affecting aesthetics[ 4 ]. Additionally, there are some disadvantages such as ineffective hemostasis and no early functional exercise, when abdominal band compression fixation is used after operation, which is easy to shift and fall off[ 4 ]. At present, with the development of minimally invasive surgery technology, minimally invasive surgery is becoming the mainstream treatment for grade I and grade II GMC[ 3 , 5 – 7 ]. According to the previous clinical experience of arthroscopic scalpel in treating GMC and the bleeding characteristics of the postoperative operation area in minimally invasive surgery for GMC, we have designed and produced a special cutter and a special hemostatic compression device, which were applied to the minimally invasive treatment of grade I and grade II GMC. To explore the clinical effect of minimally invasive treatment for grade I and II GMC using a self-made special cutter combined with a self-made special compression hemostatic device, the study retrospectively analyzed the data of 44 patients who were treated with the self-made special cutter combined with self-made special compression hemostatic device under minimally invasive surgery in our hospital. The results were compared with those of 44 patients who underwent incision GMC fasciolysis combined with abdominal belt compression hemostasis during the same period. Materials and methods Patients This retrospective study was implemented after undergoing review and approval by the hospital ethics committee. All patients were informed of their condition, voluntarily participated in the study, and signed informed consent forms. A total of 88 patients with grade Ⅰ and Ⅱ GMC were included in this study. All patients had abnormal gait, with the mild patients showing "external eight characters" while the severe ones showing "frog style". Ober's sign, sitting upright, the cross-leg test, and squat with knees together tests were positive in all patients. No bone diseases were found in the X-ray films of the pelvis and hip joint. According to different surgical instruments and hemostatic devices, they were divided into two groups. The minimally invasive group included 18 males and 26 females whose age ranged from 7 to 25 years with the course of disease ranging from 3 to 21 years. There were 27 cases of grade Ⅰ and 17 cases of grade Ⅱ who were treated with self-made special cutter for GMC combined with self-made special compression hemostasis device. While there were 44 cases in the traditional group, including 17 males and 27 females whose age ranged from 6 to 23 years with the course of disease ranging from 4 to 20 years. 25 cases of grade Ⅰ and 19 cases of grade Ⅱ in this group used open GMC fasciolysis combined with traditional abdominal band compression to stop bleeding. There were no significant differences in general data such as gender, age, grade, and discovery time between the two groups (P > 0.05) (Table 1 ). Table 1 Comparison of patient demographics between the minimally invasive and traditional groups Minimally invasive Traditional P value No. of patients 44 44 Age (yr) 15.2 ± 5.3 14.8 ± 4.1 0.637 Sex 0.828 Male 18 17 Female 26 27 Grade 0.665 Ⅰ 27 25 Ⅱ 17 19 Duration of disease (yr) 12.0 ± 4.5 13.3 ± 4.5 0.192 Inclusion and exclusion criteria The inclusion criteria were as follows: 1. age ranged from 5 to 25 years old; 2. grade Ⅰ and Ⅱ GMC; 3. follow up time was more than 1 year. The exclusion criteria were as follows: 1. age was younger than 5 years old or older than 25 years; 2. grade Ⅲ GMC; 3. the affected side had a history of trauma, surgery or other hip diseases on both sides; 4. patients with severe medical diseases and unable to tolerate surgery; 5. follow up time was less than 1 year. Structure of self-made special cutter The cutter head assembly of the self-made special cutter for GMC (Patent No.: ZL 201720411960.6) is integrally connected by the long cutter head and the short cutter head to form a "U" shape (Fig. 1 ). The length of the long cutter head is greater than that of the short cutter head. The long and short cutter heads are round and blunt, and the blade is vertically clamped between the two cutter heads. The length and width of the long head is 6 ~ 9 mm and 3 ~ 4 mm, respectively. While the length and width of the short head is 4 ~ 7 mm and 2 ~ 3 mm. The thickness of both head is 1 ~ 1.5 mm, and the distance between the two heads is 3 ~ 5 mm, which is less than the diameter of the posterior sciatic nerve. The hand-held rod is equipped with an oval recognition part that directly judges the direction of the blade. Special compression hemostasis device The special compression hemostatic device for GMC (Patent No.: ZL 201721395716.1) is composed of the first binding part and the second binding part that connected with each other (Fig. 2 ). A cloth bag structure is arranged on the first cloth body and the second cloth body, with an inflation device being placed in the bag structure. The pressurization device is connected through the trachea. The center of the bag structure and the inflation device are provided with a drainage hole, and the drainage tube is connected with the drainage bag through the drainage hole. The binding ends at both ends of the cloth body are respectively connected with the female buckle and the male buckle of the Velcro. Minimally invasive surgical Before operation, the position of greater trochanter of femur, sciatic nerve and operation incision were marked. The patients were given epidural anesthesia, rotation of lateral position for surgery. A 1.0 ~ 1.5 cm incision was made 2 cm above the posterior part of the greater trochanter of the femur. After the slightly blunt push stripping on the surface of GMC fascia, a vertical incision measuring 0.5 ~ 1.0 cm was made using a sharp knife. Then, with a self-made special cutter, the contracture fascia was pushed at an angle of 15° ~ 30° and cut through tactile sensation under blind vision. After bending, rotating, and retracting the hip joint, use a hook to cut the deep contracture band. The range of motion for hip flexion and extension during the operation is from 0° to 130°. The hip internal rotation and adduction needed to be more than 30° when the hip flexion was at 90°. The hip internal rotation and adduction also needed to be more than 20° when the hip extension was at 0°. Ober's test and cross-leg test were negative, with the bounce sign disappearing. The drainage tube was placed in the incision and passed through the drainage hole of the bag structure of the self-made special compression hemostasis device, and the drainage bag was connected to both ends of the cloth body respectively. The cloth straps on the left and right sides did not overlap; they were fastened around the pelvis in a ring. The lowest strap was fastened around the thigh, and the male and female buckles of the magic patch were respectively connected under a certain tension. The pressurizing device was used to inflate the bag structure, applying pressure to compress and stop bleeding in a large area. Open surgical The traditional group were given intravenous or epidural anesthesia, and rotated the lateral position for operation. A 3.0 ~ 8.0 cm incision was made at 2 cm above the greater trochanter of femur. Under direct vision, the contracture fascia was cut off with an electric knife, the hip joint was flexed, rotated inward and retracted. The contracture band in the deep part was cut off with a hook. The criteria for surgical satisfaction were the same as those of the minimally invasive group. After placing the skin tube in the incision for drainage, the incision was sutured, and then the abdominal band was pressurized and bandaged. Postoperative treatment The patients in minimally invasive group were fixed with a self-made special compression hemostasis device for 2–3 days to prevent the formation of hematoma and could get out of bed for functional exercise without pain (Fig. 3 ). The traditional group was fixed with abdominal band, with legs joined, knees bent and hips bent. The elastic bandage was bound to the middle and lower thighs for elastic fixation. The patients were kept in bed for 1–2 days and guided to do the flexion and adduction of hip joint activities. The patients in both groups received "one-step" functional training and kneeling exercise at the bedside without pain. The exercise adhered to step-by-step, with 3–5 groups per day and 15–25 times in each group at the early stage, and further increased the amount of exercise in the later stage for 5–8 months. Evaluation index The incision length, operation time, intraoperative bleeding and postoperative bleeding were compared between the two groups. Statistical analyses All data are provided as the mean ± standard deviation. Statistical analyses, including Student’s t-tests and χ2 test, were performed on two independent sample and the counting data comparisons respectively using SPSS26.0 statistical software. A difference was considered statistically significant if P < 0.05. Results The minimally invasive group consisted of 44 patients who were followed up for 14 to 38 months, with an average follow-up duration of 18.5 months. Similarly, the traditional group included 44 patients who were followed up for 15 to 33 months, with an average follow-up duration of 19.5 months. There were no complications such as infection, hip instability and sciatic nerve injury in both groups. The cross-leg test, squatting with knees together, gait and movement returned to normal, and Ober's and frog leg symptoms were negative. One patient in the traditional group had secondary hematoma after incision, which was cured by incision and drainage again. The incision length (1.3 ± 0.2 cm) in the minimally invasive group was significantly shorter than that in the traditional group (6.4 ± 1.4 cm), so was the operation time (46.3 ± 7.9 min vs. 62.2 ± 15.1 min). Meanwhile, the amount of intraoperative bleeding (33.7 ± 11.5 ml vs. 60.9 ± 25.0) ml) and postoperative bleeding (51.1 ± 19.4 vs. 112.9 ± 36.2ml) of patients in the minimally invasive group was significantly lower than that in the traditional group, respectively (P < 0.05) (Table 2 ). According to the standard of Zhang et al, the validity of the treatment in minimally invasive group were excellent[ 5 ]. Table 2 Comparison of operating data between the minimally invasive and traditional groups Group Cases Incision length (cm) Operating time (min) Intraoperative bleeding (ml) Postoperative bleeding (ml) Minimally invasive 44 1.3 ± 0.2 46.3 ± 7.9 33.7 ± 11.5 51.1 ± 19.4 Traditional 44 6.4 ± 1.4 62.2 ± 15.1 60.9 ± 25.0 112.9 ± 36.2 P - < 0.05 < 0.05 < 0.05 < 0.05 Discussion GMC is a clinical syndrome group in which the local fascia of gluteal muscle undergoes fibrous degeneration and contracture, resulting in dysfunction of hip joint adduction and internal rotation, leading to distinctive signs and gait[ 1 , 8 – 11 ]. With the continuous in-depth study of GMC, the treatment concept of GMC tends to be minimally invasive[ 5 ]. Clinically, improved minimally invasive surgery for GMC, combined with postoperative compression and hemostasis, can achieve early functional exercise and yield good therapeutic effects [ 1 – 3 , 6 , 8 ]. Its advantage lies in achieving optimal release effects with minimal physiological invasion. In the study, the minimally invasive treatment of grade Ⅰ and grade Ⅱ GMC with self-made special cutter combined with self-made special compression hemostasis device is based on the good effect of minimally invasive arthroscopic scalpel technology in treating GMC. This is achieved through the continuous improvement of arthroscopic scalpel and postoperative compression hemostasis device. Currently, minimally invasive fascia release is the mainstream treatment for grade Ⅰ and Ⅱ GMC[ 12 – 14 ]. To overcome the limitations of traditional contracture fasciolysis, transdiscoscopy, and arthroscopy, we improved the knee arthroscopic scalpel and postoperative compression hemostasis device based on the previous knee arthroscopic scalpel for GMC treatment[ 12 ]. Additionally, a special cutter and a specialized compression hemostasis device were designed for minimally invasive treatment of grade Ⅰ and Ⅱ GMC. The lesion sites of grade Ⅰ and Ⅱ GMC involve the gluteal muscle fascia and the posterior 1/3 to 1/2 of the iliotibial tract. The contracture fascia of the gluteus maximus and the posterior part of the iliotibial band can be cut off using a self-made cutter, achieving relief of symptoms or the disappearance of positive signs. Compared with the traditional surgical method, the contracture fascia was accurately judged and cut off by using the hand feeling of the self-made special cutter, which significantly reduced the invasion and damage to the skin and the tissue around the contracture fascia. However, the grade Ⅲ GMC is a contraindication for minimally invasive GMC fascial release because the deep contracture tissue cannot be accurately assessed by hand during minimally invasive surgery, and reluctantly performing this operation often fails to achieve satisfactory therapeutic results. Compression fixation of abdominal belt is often used after GMC surgery. However, due to the bucket-shaped design structure of the abdominal belt fixed on the buttock, it is prone to shifting and falling off easily, leading to complications such as local hematoma and infection, which can affect early functional exercise for patients. To overcome the limitation of postoperative hemostasis in the surgical area, we have made improvements to the hemostasis device based on the previous method of abdominal belt compression fixation. The self-made special compression hemostatic device applies uniform pressure and achieves accurate hemostasis by pressurizing the corresponding subcutaneous bleeding area through inflation, expansion, and compression of the capsule structure. The device avoids covering the perineum area with cloth, which is conducive to the patient's ability to urinate without loosening the special compression hemostasis device, thus achieving continuous and effective compression hemostasis. In the study, a self-made compression hemostasis device was used for all patients in the minimally invasive group to achieve compression hemostasis. It can compress a large area of bleeding, reduce postoperative wound exudation, effectively promote drainage, eliminate residual dead space, prevent secondary hematoma and infection complications, help patients to get out of bed and recover early, and reduce the workload of medical care. The results of this study showed that the minimally invasive treatment of grade Ⅰ and Ⅱ GMC with self-made special cutter combined with self-made special compression hemostasis device can achieve effective relaxation and hemostasis, thus meeting the requirements for early functional exercise. One patient in the traditional group experienced a secondary hematoma after the incision, which was successfully treated through re-incision and drainage. There were no complications such as infection, hip instability and sciatic nerve injury in both groups. The cross-leg test, squat with knees together, gait and movement returned to normal, and Ober's symptom and frog leg symptom were negative. The length of incision and operation time in the minimally invasive group were significantly shorter than those in the open group, and the amount of intraoperative bleeding and postoperative bleeding were significantly less than those in the open group (P < 0.05). The evaluation results of the minimally invasive group were excellent. It has been shown that using a self-made special cutter to minimally cut the contracted fascia can reduce bleeding and trauma during surgery, as well as postoperative pain. After the operation, the use of a self-made special compression hemostasis device can effectively stop bleeding and provide firm fixation. This allows patients to engage in early functional exercises, which is beneficial for functional recovery. Grade Ⅰ and Ⅱ GMC are the best indications for minimally invasive treatment using a self-made special cutter combined with a self-made special compression hemostasis device. Compared with traditional surgery, this technique demonstrates obvious advantages in the treatment of GMC. Key points of the operation include: 1. Regularly assessing the range of motion of the hip joint in adduction, flexion, and extension positions before surgery. On this basis, repeatedly extend and flex the hip joint in the adduction position during the operation to determine whether the contracture fascia is properly released, thus avoiding incomplete release during surgery and achieving the desired treatment effect. 2. According to the course of greater trochanter of femur, GMC zone and sciatic nerve marked on the body surface in lateral position, predict the range of GMC zone when the hip joint is in the maximum extension and flexion position. An incision of 1.2 to 1.5 cm was made 2 cm above the posterior part of the greater trochanter of the femur. Because the contracture tissue of gluteus maximus and iliotibial tract is fan-shaped, its contracture axis is located at the starting point of the greater trochanter of the femur, and a gap of 0.5 to 1.0 cm is cut at the contracture axis with a sharp knife. Under the blind method, the contracture fascia was inferred forward based on body surface marks and the hand feeling of using a special knife, infer the contracture of gluteus maximus fascia and posterior 1/3 to 1/2 of the iliotibial tract backward to achieve complete release. 3. The operator is required to have a solid anatomical foundation, skilled open surgical skills and good hand feeling of knife operation, accurately judge the contracture tissue during operation and maintain the maximum tension, and cut it off with a self-made cutter. 4. During the operation, the contracture fascia enters between the two heads of the cutter. The long cutter head is on the contracture fascia, while the short cutter head is under it. The blade is perpendicular to the fascia, and the rod is pushed at an angle ranging from 15° to 30° relative to the surface of the fascia. The pushing force of the cutter is well controlled. The long flat cutter head pushes away the soft tissue on the contracture fascia, while avoiding the whole cutter head to poke into the muscle layer and reducing the damage to the tissue under the fascia. The sound of "rustling" contracture and rupture of fascia layer can be heard. 5. The cutter edge is located between the long and short cutter heads, and it is shorter than both of them with a spacing of 3 to 5mm, which is smaller than the thick sciatic nerve in the rear. Even if the long and short cutter head is pushed backward and touches the sciatic nerve in the rear, it will not be damaged with high safety. The operation can be completed through a small incision to achieve effective relaxation, thereby further realizing the concept of minimally invasive treatment for GMC and avoiding problems such as numbness and paralysis. Postoperative rehabilitation is very important, active and orderly postoperative rehabilitation exercise can effectively improve the curative effect[ 15 ]. The early postoperative rehabilitation functional exercises should be gradual and proactive to prevent the formation of contracture in the affected area, while the later stage primarily focuses on restoring hip function and shape. Conclusion In conclusion, the use of a minimally invasive self-made special cutter for release and the application of a self-made special compression hemostatic device can achieve favorable clinical outcomes in grade I and grade II GMC patients. Compared to open surgery, it causes less trauma, simplifies the operation, reduces intraoperative and postoperative bleeding, allows for early functional exercise, and promotes rapid functional recovery. Abbreviations GMC: Gluteal muscle contracture Declarations Ethics approval and consent to participate This study was approved by the ethics committee of Sihong Hospital. Informed consent was obtained from all individual participants included in the study. The whole research process follows the Declaration of Helsinki. Consent for publication The patients provided informed consent to the publication of their pictures as well as their anonymous and clustered data. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This study was sponsored by the medical research project of Jiangsu Provincial Health Commission (Z2023079). Authors' Contributions ZYY contributed to the study conception and design. YGY, ZXP and DCZ contributed to the collection of clinical and radiological data; LLS and YW contributed to statistical analysis; YGY and ZXP contributed to the writing and editing. All authors have read and approved the final manuscript. Acknowledgements None References Ma J, Huang Z, Huang Q, Zhou Z, Pei F, Shen B. 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Rai S, Meng C, Wang X, Chaudhary N, Jin S, Yang S, et al. Gluteal muscle contracture: diagnosis and management options. SICOT J. 2017;3:1. Hu J, Zhu J, Zhou Z, Yang X, Zhu M, Wu P. Clinical Outcomes of Arthroscopic Surgery in Patients with Gluteal Muscle Contracture: Single-Institution Results from a High-Volume Cohort. Med Sci Monit. 2024;30:e942945. Reilly AL, Owori FR, Obaikol R, Asige E, Aluka H, Penny N, et al. Surgical Release of Gluteal Fibrosis in Children Results in Sustained Benefit at 5-Year Follow-up. J Pediatr Orthop. 2021;41(3):e240–5. Zhang Y, Su Q, Zhang Y, Ge H, Wei W, Cheng B. Multivariate analysis of the relationship between gluteal muscle contracture and coxa valga. BMC Musculoskelet Disord. 2021;22(1):561. Yuan BT, Qu F, Wang SX, Qi W, Shen XZ, Li CB, et al. Histology and molecular pathology of iliotibial tract contracture in patients with gluteal muscle contracture. Biosci Rep. 2019;39(9):BSR20181351. Mittal R, Jain S. Bilateral gluteus maximus contracture due to intra muscular injections. Trop Doct. 2021;51(3):450–2. Ye B, Zhou P, Xia Y, Chen Y, Yu J, Xu S. New minimally invasive option for the treatment of gluteal muscle contracture. Orthopedics. 2012;35(12):e1692–8. Zhao FY, Dong HM, Huang HJ, Gao GY, Wu RQ, Shi YY, et al. The Application of Arthroscopic Techniques in the Diagnosis and Treatment of Hip-Related Conditions in China. Orthop Surg. 2021;13(6):1697–706. Dai Z, Chen Z, Liao Y, Tang Z, Cui J. Comparison of arthroscopic versus open surgery on external snapping hip caused by gluteal muscle contracture. Hip Int. 2018;28(2):173–7. Rai S, Jin S, Meng C, Chaudhary N, Tamang N, Wang X, et al. Arthroscopic release using F and C method versus conventional open release method in the treatment of gluteal muscle contracture: a comparative study. BMC Musculoskelet Disord. 2017;18(1):113. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Dec, 2024 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 15 Nov, 2024 Reviews received at journal 14 Nov, 2024 Reviews received at journal 19 Oct, 2024 Reviewers agreed at journal 14 Oct, 2024 Reviewers agreed at journal 24 Sep, 2024 Reviewers agreed at journal 26 Jul, 2024 Reviews received at journal 14 Jul, 2024 Reviewers agreed at journal 25 Jun, 2024 Reviewers agreed at journal 23 Jun, 2024 Reviewers invited by journal 22 Jun, 2024 Editor invited by journal 20 Jun, 2024 Editor assigned by journal 20 Jun, 2024 Submission checks completed at journal 20 Jun, 2024 First submitted to journal 12 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4571213","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":323366821,"identity":"6ed5ede4-8f94-48a1-9a2c-350700aea88a","order_by":0,"name":"Yingguo Yang","email":"","orcid":"","institution":"Sihong Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yingguo","middleName":"","lastName":"Yang","suffix":""},{"id":323366822,"identity":"200f73de-0437-4222-9b23-035da2931728","order_by":1,"name":"Zixuan Peng","email":"","orcid":"","institution":"Kangda College of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zixuan","middleName":"","lastName":"Peng","suffix":""},{"id":323366823,"identity":"03412c01-a044-4ebf-9615-6c45e6c79485","order_by":2,"name":"Linlin Shi","email":"","orcid":"","institution":"Sihong Hospital","correspondingAuthor":false,"prefix":"","firstName":"Linlin","middleName":"","lastName":"Shi","suffix":""},{"id":323366824,"identity":"b08f5742-ce51-4876-a70b-389dc24ca51b","order_by":3,"name":"Ye Wang","email":"","orcid":"","institution":"Sihong Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ye","middleName":"","lastName":"Wang","suffix":""},{"id":323366825,"identity":"4e5d0c26-f8df-4ff8-a616-44a20c92870a","order_by":4,"name":"Dongcheng Zhu","email":"","orcid":"","institution":"Sihong Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dongcheng","middleName":"","lastName":"Zhu","suffix":""},{"id":323366826,"identity":"29f3a977-9b50-4031-83f3-45fa5d06d885","order_by":5,"name":"Zhiyuan Ye","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYDACCcYGMG3A3sBwgEQtPAeI1gKlDSQSiHSX/OzmNmmemjty5pLPHx4uqGGQ5xcjYBnjnINALceeGVvOzjE4POMYg+HM2QSsY5ZIBGphO5y44XYOw2EeNoYEg9sEtLCBtfwDarl5/MFhnn9EaOEBaeFtA2q5wWBwmLeNCC0SEonNlnP7Dhtb9gD9wtsnQdgv8jPSH9548+2wnDn78cefeb7ZyPNLE9ACBCwSSBwJnMqQAfMHopSNglEwCkbByAUA+gNC1Ep78ncAAAAASUVORK5CYII=","orcid":"","institution":"Sihong Hospital","correspondingAuthor":true,"prefix":"","firstName":"Zhiyuan","middleName":"","lastName":"Ye","suffix":""}],"badges":[],"createdAt":"2024-06-12 15:11:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4571213/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4571213/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-024-08150-1","type":"published","date":"2024-12-19T15:58:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60609764,"identity":"0952a6e4-9ee2-4d9c-b6da-5b50f08153c7","added_by":"auto","created_at":"2024-07-18 18:22:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":4683769,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Structure diagram of a self-made special cutter for gluteal muscle contracture. (B) Different specifications of the self-made special cutters. (C) The self-made cutters are used during surgery.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4571213/v1/c43da12046d17232cc6f683a.png"},{"id":60609763,"identity":"6e5b1c60-ca28-4d67-9571-ba723fe5acbb","added_by":"auto","created_at":"2024-07-18 18:22:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1890861,"visible":true,"origin":"","legend":"\u003cp\u003e(A-B) The first cloth and second cloth of a special compression hemostatic device for gluteal muscle contracture. (C) Scheme diagram illustrating the application state of a specialized compression hemostasis device. (D) Self-made compression hemostasis device for gluteal muscle contracture.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4571213/v1/c9e75bd81d1725ffc4396c2d.png"},{"id":60609762,"identity":"c89250d9-668f-4769-8bef-f945d88d577b","added_by":"auto","created_at":"2024-07-18 18:22:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":5402889,"visible":true,"origin":"","legend":"\u003cp\u003e(A-D) Demonstration of a self-made compression hemostasis device for patient with gluteal muscle contracture after surgery.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4571213/v1/e958d8dfce1f7e27b460f223.png"},{"id":72202747,"identity":"4fe7ee16-6f40-4797-8957-bb3eb8535650","added_by":"auto","created_at":"2024-12-23 16:15:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":14379804,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4571213/v1/38f00fbf-0c7b-4a19-8961-b35a2ca50634.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Minimally invasive treatment of grade I and II gluteal muscle contracture using a self-made special cutter combined with a specialized compression hemostasis device","fulltext":[{"header":"Background","content":"\u003cp\u003eIn recent years, surgical treatment of gluteal muscle contracture (GMC) has become a research hotspot[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, open surgery has complications such as severe trauma, more bleeding, obvious influence on postoperative muscle strength, slow functional recovery, and surgical scar affecting aesthetics[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, there are some disadvantages such as ineffective hemostasis and no early functional exercise, when abdominal band compression fixation is used after operation, which is easy to shift and fall off[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. At present, with the development of minimally invasive surgery technology, minimally invasive surgery is becoming the mainstream treatment for grade I and grade II GMC[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. According to the previous clinical experience of arthroscopic scalpel in treating GMC and the bleeding characteristics of the postoperative operation area in minimally invasive surgery for GMC, we have designed and produced a special cutter and a special hemostatic compression device, which were applied to the minimally invasive treatment of grade I and grade II GMC.\u003c/p\u003e \u003cp\u003eTo explore the clinical effect of minimally invasive treatment for grade I and II GMC using a self-made special cutter combined with a self-made special compression hemostatic device, the study retrospectively analyzed the data of 44 patients who were treated with the self-made special cutter combined with self-made special compression hemostatic device under minimally invasive surgery in our hospital. The results were compared with those of 44 patients who underwent incision GMC fasciolysis combined with abdominal belt compression hemostasis during the same period.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003e This retrospective study was implemented after undergoing review and approval by the hospital ethics committee. All patients were informed of their condition, voluntarily participated in the study, and signed informed consent forms. A total of 88 patients with grade Ⅰ and Ⅱ GMC were included in this study. All patients had abnormal gait, with the mild patients showing \"external eight characters\" while the severe ones showing \"frog style\". Ober's sign, sitting upright, the cross-leg test, and squat with knees together tests were positive in all patients. No bone diseases were found in the X-ray films of the pelvis and hip joint. According to different surgical instruments and hemostatic devices, they were divided into two groups. The minimally invasive group included 18 males and 26 females whose age ranged from 7 to 25 years with the course of disease ranging from 3 to 21 years. There were 27 cases of grade Ⅰ and 17 cases of grade Ⅱ who were treated with self-made special cutter for GMC combined with self-made special compression hemostasis device. While there were 44 cases in the traditional group, including 17 males and 27 females whose age ranged from 6 to 23 years with the course of disease ranging from 4 to 20 years. 25 cases of grade Ⅰ and 19 cases of grade Ⅱ in this group used open GMC fasciolysis combined with traditional abdominal band compression to stop bleeding. There were no significant differences in general data such as gender, age, grade, and discovery time between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of patient demographics between the minimally invasive and traditional groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimally invasive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (yr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of disease (yr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria were as follows: 1. age ranged from 5 to 25 years old; 2. grade Ⅰ and Ⅱ GMC; 3. follow up time was more than 1 year. The exclusion criteria were as follows: 1. age was younger than 5 years old or older than 25 years; 2. grade Ⅲ GMC; 3. the affected side had a history of trauma, surgery or other hip diseases on both sides; 4. patients with severe medical diseases and unable to tolerate surgery; 5. follow up time was less than 1 year.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStructure of self-made special cutter\u003c/h2\u003e \u003cp\u003eThe cutter head assembly of the self-made special cutter for GMC (Patent No.: ZL 201720411960.6) is integrally connected by the long cutter head and the short cutter head to form a \"U\" shape (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The length of the long cutter head is greater than that of the short cutter head. The long and short cutter heads are round and blunt, and the blade is vertically clamped between the two cutter heads. The length and width of the long head is 6\u0026thinsp;~\u0026thinsp;9 mm and 3\u0026thinsp;~\u0026thinsp;4 mm, respectively. While the length and width of the short head is 4\u0026thinsp;~\u0026thinsp;7 mm and 2\u0026thinsp;~\u0026thinsp;3 mm. The thickness of both head is 1\u0026thinsp;~\u0026thinsp;1.5 mm, and the distance between the two heads is 3\u0026thinsp;~\u0026thinsp;5 mm, which is less than the diameter of the posterior sciatic nerve. The hand-held rod is equipped with an oval recognition part that directly judges the direction of the blade.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSpecial compression hemostasis device\u003c/h2\u003e \u003cp\u003eThe special compression hemostatic device for GMC (Patent No.: ZL 201721395716.1) is composed of the first binding part and the second binding part that connected with each other (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A cloth bag structure is arranged on the first cloth body and the second cloth body, with an inflation device being placed in the bag structure. The pressurization device is connected through the trachea. The center of the bag structure and the inflation device are provided with a drainage hole, and the drainage tube is connected with the drainage bag through the drainage hole. The binding ends at both ends of the cloth body are respectively connected with the female buckle and the male buckle of the Velcro.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMinimally invasive surgical\u003c/h2\u003e \u003cp\u003eBefore operation, the position of greater trochanter of femur, sciatic nerve and operation incision were marked. The patients were given epidural anesthesia, rotation of lateral position for surgery. A 1.0\u0026thinsp;~\u0026thinsp;1.5 cm incision was made 2 cm above the posterior part of the greater trochanter of the femur. After the slightly blunt push stripping on the surface of GMC fascia, a vertical incision measuring 0.5\u0026thinsp;~\u0026thinsp;1.0 cm was made using a sharp knife. Then, with a self-made special cutter, the contracture fascia was pushed at an angle of 15\u0026deg; ~ 30\u0026deg; and cut through tactile sensation under blind vision. After bending, rotating, and retracting the hip joint, use a hook to cut the deep contracture band. The range of motion for hip flexion and extension during the operation is from 0\u0026deg; to 130\u0026deg;. The hip internal rotation and adduction needed to be more than 30\u0026deg; when the hip flexion was at 90\u0026deg;. The hip internal rotation and adduction also needed to be more than 20\u0026deg; when the hip extension was at 0\u0026deg;. Ober's test and cross-leg test were negative, with the bounce sign disappearing. The drainage tube was placed in the incision and passed through the drainage hole of the bag structure of the self-made special compression hemostasis device, and the drainage bag was connected to both ends of the cloth body respectively. The cloth straps on the left and right sides did not overlap; they were fastened around the pelvis in a ring. The lowest strap was fastened around the thigh, and the male and female buckles of the magic patch were respectively connected under a certain tension. The pressurizing device was used to inflate the bag structure, applying pressure to compress and stop bleeding in a large area.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eOpen surgical\u003c/h2\u003e \u003cp\u003eThe traditional group were given intravenous or epidural anesthesia, and rotated the lateral position for operation. A 3.0\u0026thinsp;~\u0026thinsp;8.0 cm incision was made at 2 cm above the greater trochanter of femur. Under direct vision, the contracture fascia was cut off with an electric knife, the hip joint was flexed, rotated inward and retracted. The contracture band in the deep part was cut off with a hook. The criteria for surgical satisfaction were the same as those of the minimally invasive group. After placing the skin tube in the incision for drainage, the incision was sutured, and then the abdominal band was pressurized and bandaged.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003ePostoperative treatment\u003c/h2\u003e \u003cp\u003eThe patients in minimally invasive group were fixed with a self-made special compression hemostasis device for 2\u0026ndash;3 days to prevent the formation of hematoma and could get out of bed for functional exercise without pain (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The traditional group was fixed with abdominal band, with legs joined, knees bent and hips bent. The elastic bandage was bound to the middle and lower thighs for elastic fixation. The patients were kept in bed for 1\u0026ndash;2 days and guided to do the flexion and adduction of hip joint activities. The patients in both groups received \"one-step\" functional training and kneeling exercise at the bedside without pain. The exercise adhered to step-by-step, with 3\u0026ndash;5 groups per day and 15\u0026ndash;25 times in each group at the early stage, and further increased the amount of exercise in the later stage for 5\u0026ndash;8 months.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation index\u003c/h2\u003e \u003cp\u003eThe incision length, operation time, intraoperative bleeding and postoperative bleeding were compared between the two groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eAll data are provided as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Statistical analyses, including Student\u0026rsquo;s t-tests and χ2 test, were performed on two independent sample and the counting data comparisons respectively using SPSS26.0 statistical software. A difference was considered statistically significant if P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe minimally invasive group consisted of 44 patients who were followed up for 14 to 38 months, with an average follow-up duration of 18.5 months. Similarly, the traditional group included 44 patients who were followed up for 15 to 33 months, with an average follow-up duration of 19.5 months. There were no complications such as infection, hip instability and sciatic nerve injury in both groups. The cross-leg test, squatting with knees together, gait and movement returned to normal, and Ober's and frog leg symptoms were negative. One patient in the traditional group had secondary hematoma after incision, which was cured by incision and drainage again. The incision length (1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 cm) in the minimally invasive group was significantly shorter than that in the traditional group (6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 cm), so was the operation time (46.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9 min vs. 62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1 min). Meanwhile, the amount of intraoperative bleeding (33.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5 ml vs. 60.9\u0026thinsp;\u0026plusmn;\u0026thinsp;25.0) ml) and postoperative bleeding (51.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.4 vs. 112.9\u0026thinsp;\u0026plusmn;\u0026thinsp;36.2ml) of patients in the minimally invasive group was significantly lower than that in the traditional group, respectively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). According to the standard of Zhang et al, the validity of the treatment in minimally invasive group were excellent[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of operating data between the minimally invasive and traditional groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncision length (cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOperating time (min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntraoperative bleeding (ml)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePostoperative bleeding (ml)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimally invasive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraditional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60.9\u0026thinsp;\u0026plusmn;\u0026thinsp;25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e112.9\u0026thinsp;\u0026plusmn;\u0026thinsp;36.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eGMC is a clinical syndrome group in which the local fascia of gluteal muscle undergoes fibrous degeneration and contracture, resulting in dysfunction of hip joint adduction and internal rotation, leading to distinctive signs and gait[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. With the continuous in-depth study of GMC, the treatment concept of GMC tends to be minimally invasive[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Clinically, improved minimally invasive surgery for GMC, combined with postoperative compression and hemostasis, can achieve early functional exercise and yield good therapeutic effects [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Its advantage lies in achieving optimal release effects with minimal physiological invasion. In the study, the minimally invasive treatment of grade Ⅰ and grade Ⅱ GMC with self-made special cutter combined with self-made special compression hemostasis device is based on the good effect of minimally invasive arthroscopic scalpel technology in treating GMC. This is achieved through the continuous improvement of arthroscopic scalpel and postoperative compression hemostasis device.\u003c/p\u003e \u003cp\u003eCurrently, minimally invasive fascia release is the mainstream treatment for grade Ⅰ and Ⅱ GMC[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. To overcome the limitations of traditional contracture fasciolysis, transdiscoscopy, and arthroscopy, we improved the knee arthroscopic scalpel and postoperative compression hemostasis device based on the previous knee arthroscopic scalpel for GMC treatment[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, a special cutter and a specialized compression hemostasis device were designed for minimally invasive treatment of grade Ⅰ and Ⅱ GMC. The lesion sites of grade Ⅰ and Ⅱ GMC involve the gluteal muscle fascia and the posterior 1/3 to 1/2 of the iliotibial tract. The contracture fascia of the gluteus maximus and the posterior part of the iliotibial band can be cut off using a self-made cutter, achieving relief of symptoms or the disappearance of positive signs. Compared with the traditional surgical method, the contracture fascia was accurately judged and cut off by using the hand feeling of the self-made special cutter, which significantly reduced the invasion and damage to the skin and the tissue around the contracture fascia. However, the grade Ⅲ GMC is a contraindication for minimally invasive GMC fascial release because the deep contracture tissue cannot be accurately assessed by hand during minimally invasive surgery, and reluctantly performing this operation often fails to achieve satisfactory therapeutic results.\u003c/p\u003e \u003cp\u003eCompression fixation of abdominal belt is often used after GMC surgery. However, due to the bucket-shaped design structure of the abdominal belt fixed on the buttock, it is prone to shifting and falling off easily, leading to complications such as local hematoma and infection, which can affect early functional exercise for patients. To overcome the limitation of postoperative hemostasis in the surgical area, we have made improvements to the hemostasis device based on the previous method of abdominal belt compression fixation. The self-made special compression hemostatic device applies uniform pressure and achieves accurate hemostasis by pressurizing the corresponding subcutaneous bleeding area through inflation, expansion, and compression of the capsule structure. The device avoids covering the perineum area with cloth, which is conducive to the patient's ability to urinate without loosening the special compression hemostasis device, thus achieving continuous and effective compression hemostasis. In the study, a self-made compression hemostasis device was used for all patients in the minimally invasive group to achieve compression hemostasis. It can compress a large area of bleeding, reduce postoperative wound exudation, effectively promote drainage, eliminate residual dead space, prevent secondary hematoma and infection complications, help patients to get out of bed and recover early, and reduce the workload of medical care.\u003c/p\u003e \u003cp\u003eThe results of this study showed that the minimally invasive treatment of grade Ⅰ and Ⅱ GMC with self-made special cutter combined with self-made special compression hemostasis device can achieve effective relaxation and hemostasis, thus meeting the requirements for early functional exercise. One patient in the traditional group experienced a secondary hematoma after the incision, which was successfully treated through re-incision and drainage. There were no complications such as infection, hip instability and sciatic nerve injury in both groups. The cross-leg test, squat with knees together, gait and movement returned to normal, and Ober's symptom and frog leg symptom were negative. The length of incision and operation time in the minimally invasive group were significantly shorter than those in the open group, and the amount of intraoperative bleeding and postoperative bleeding were significantly less than those in the open group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The evaluation results of the minimally invasive group were excellent. It has been shown that using a self-made special cutter to minimally cut the contracted fascia can reduce bleeding and trauma during surgery, as well as postoperative pain. After the operation, the use of a self-made special compression hemostasis device can effectively stop bleeding and provide firm fixation. This allows patients to engage in early functional exercises, which is beneficial for functional recovery.\u003c/p\u003e \u003cp\u003eGrade Ⅰ and Ⅱ GMC are the best indications for minimally invasive treatment using a self-made special cutter combined with a self-made special compression hemostasis device. Compared with traditional surgery, this technique demonstrates obvious advantages in the treatment of GMC. Key points of the operation include: 1. Regularly assessing the range of motion of the hip joint in adduction, flexion, and extension positions before surgery. On this basis, repeatedly extend and flex the hip joint in the adduction position during the operation to determine whether the contracture fascia is properly released, thus avoiding incomplete release during surgery and achieving the desired treatment effect. 2. According to the course of greater trochanter of femur, GMC zone and sciatic nerve marked on the body surface in lateral position, predict the range of GMC zone when the hip joint is in the maximum extension and flexion position. An incision of 1.2 to 1.5 cm was made 2 cm above the posterior part of the greater trochanter of the femur. Because the contracture tissue of gluteus maximus and iliotibial tract is fan-shaped, its contracture axis is located at the starting point of the greater trochanter of the femur, and a gap of 0.5 to 1.0 cm is cut at the contracture axis with a sharp knife. Under the blind method, the contracture fascia was inferred forward based on body surface marks and the hand feeling of using a special knife, infer the contracture of gluteus maximus fascia and posterior 1/3 to 1/2 of the iliotibial tract backward to achieve complete release. 3. The operator is required to have a solid anatomical foundation, skilled open surgical skills and good hand feeling of knife operation, accurately judge the contracture tissue during operation and maintain the maximum tension, and cut it off with a self-made cutter. 4. During the operation, the contracture fascia enters between the two heads of the cutter. The long cutter head is on the contracture fascia, while the short cutter head is under it. The blade is perpendicular to the fascia, and the rod is pushed at an angle ranging from 15\u0026deg; to 30\u0026deg; relative to the surface of the fascia. The pushing force of the cutter is well controlled. The long flat cutter head pushes away the soft tissue on the contracture fascia, while avoiding the whole cutter head to poke into the muscle layer and reducing the damage to the tissue under the fascia. The sound of \"rustling\" contracture and rupture of fascia layer can be heard. 5. The cutter edge is located between the long and short cutter heads, and it is shorter than both of them with a spacing of 3 to 5mm, which is smaller than the thick sciatic nerve in the rear. Even if the long and short cutter head is pushed backward and touches the sciatic nerve in the rear, it will not be damaged with high safety. The operation can be completed through a small incision to achieve effective relaxation, thereby further realizing the concept of minimally invasive treatment for GMC and avoiding problems such as numbness and paralysis.\u003c/p\u003e \u003cp\u003ePostoperative rehabilitation is very important, active and orderly postoperative rehabilitation exercise can effectively improve the curative effect[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The early postoperative rehabilitation functional exercises should be gradual and proactive to prevent the formation of contracture in the affected area, while the later stage primarily focuses on restoring hip function and shape.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the use of a minimally invasive self-made special cutter for release and the application of a self-made special compression hemostatic device can achieve favorable clinical outcomes in grade I and grade II GMC patients. Compared to open surgery, it causes less trauma, simplifies the operation, reduces intraoperative and postoperative bleeding, allows for early functional exercise, and promotes rapid functional recovery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGMC: Gluteal muscle contracture\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of Sihong Hospital. Informed consent was obtained from all individual participants included in the study. The whole research process follows the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients provided informed consent to the publication of their pictures as well as their anonymous and clustered data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was sponsored by the medical research project of Jiangsu Provincial Health Commission (Z2023079).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZYY contributed to the study conception and design.\u0026nbsp;YGY, ZXP and\u0026nbsp;DCZ contributed to the collection of clinical and radiological data; LLS and YW contributed to statistical analysis; YGY and ZXP contributed to the writing and editing. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMa J, Huang Z, Huang Q, Zhou Z, Pei F, Shen B. Tranexamic acid combined with compression dressing reduces blood loss in gluteal muscle contracture surgery. BMC Surg. 2022;22(1):46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang X, Qi W, Liu Y, Xiang Y, Zhang B, Li H, et al. Arthroscopic C-Shaped Release Around the Greater Trochanter for Gluteal Muscle Contracture. Orthop Surg. 2021;13(6):1765\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao SG, Liu WJ, Yang M, Li JP, Su C, Kuang SD, et al. Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals: a retrospective analysis of 118 consecutive cases. BMC Musculoskelet Disord. 2021;22(1):28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang Y, Li T, Wang L, Chen G, Li J. Comparison of open surgery versus endoscopic-assisted release for gluteal muscle contracture: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1):39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang T, Xu S, Li H, He X, Zhang F. Comparison of the clinical effects of arthroscopic surgery vs. open surgery for grade II gluteal muscle contracture in adults. Exp Ther Med. 2018;16(1):364\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRai S, Meng C, Wang X, Chaudhary N, Jin S, Yang S, et al. Gluteal muscle contracture: diagnosis and management options. SICOT J. 2017;3:1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu J, Zhu J, Zhou Z, Yang X, Zhu M, Wu P. Clinical Outcomes of Arthroscopic Surgery in Patients with Gluteal Muscle Contracture: Single-Institution Results from a High-Volume Cohort. Med Sci Monit. 2024;30:e942945.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReilly AL, Owori FR, Obaikol R, Asige E, Aluka H, Penny N, et al. Surgical Release of Gluteal Fibrosis in Children Results in Sustained Benefit at 5-Year Follow-up. J Pediatr Orthop. 2021;41(3):e240\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Su Q, Zhang Y, Ge H, Wei W, Cheng B. Multivariate analysis of the relationship between gluteal muscle contracture and coxa valga. BMC Musculoskelet Disord. 2021;22(1):561.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan BT, Qu F, Wang SX, Qi W, Shen XZ, Li CB, et al. Histology and molecular pathology of iliotibial tract contracture in patients with gluteal muscle contracture. Biosci Rep. 2019;39(9):BSR20181351.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMittal R, Jain S. Bilateral gluteus maximus contracture due to intra muscular injections. Trop Doct. 2021;51(3):450\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYe B, Zhou P, Xia Y, Chen Y, Yu J, Xu S. New minimally invasive option for the treatment of gluteal muscle contracture. Orthopedics. 2012;35(12):e1692\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao FY, Dong HM, Huang HJ, Gao GY, Wu RQ, Shi YY, et al. The Application of Arthroscopic Techniques in the Diagnosis and Treatment of Hip-Related Conditions in China. Orthop Surg. 2021;13(6):1697\u0026ndash;706.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDai Z, Chen Z, Liao Y, Tang Z, Cui J. Comparison of arthroscopic versus open surgery on external snapping hip caused by gluteal muscle contracture. Hip Int. 2018;28(2):173\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRai S, Jin S, Meng C, Chaudhary N, Tamang N, Wang X, et al. Arthroscopic release using F and C method versus conventional open release method in the treatment of gluteal muscle contracture: a comparative study. BMC Musculoskelet Disord. 2017;18(1):113.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Minimally invasive, gluteal muscle contracture, cutter, oppression","lastPublishedDoi":"10.21203/rs.3.rs-4571213/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4571213/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo explore the method and curative effect of minimally invasive treatment of gluteal muscle contracture (GMC) with self-made special cutter combined with special compression hemostasis device.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe data of 88 patients with GMC treated in our hospital from May 2017 to January 2021 were analyzed retrospectively. They were divided into two groups according to different surgical instruments and hemostatic devices. There were 44 cases in the minimally invasive group, including 18 males and 26 females whose age ranged from 7 to 25 years with the course of disease ranging from 3 to 21 years. There were 27 cases of grade Ⅰ and 17 cases of grade Ⅱ who were treated with self-made special cutter for GMC combined with self-made special compression hemostasis device. While there were 44 cases in the traditional group, including 17 males and 27 females whose age ranged from 6 to 23 years with the course of disease ranging from 4 to 20 years. 25 cases of grade Ⅰ and 19 cases of grade Ⅱ in this group used open gluteal contracture fasciolysis combined with traditional abdominal band compression to stop bleeding. The incision length, operation time, intraoperative bleeding and postoperative bleeding were compared between the two groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were no complications such as infection, hip instability and sciatic nerve injury in the two groups. The cross-leg test, knee squat, gait and movement returned to normal. Ad Ober's symptom and frog leg symptom were negative. One patient in the traditional group had secondary hematoma after incision, which was cured by incision and drainage again. The incision length (1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 cm) in the minimally invasive group was significantly shorter than that in the traditional group (6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 cm), as was the operation time (46.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9 min vs 62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1 min). Meanwhile, the amount of intraoperative bleeding (33.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5 ml vs 60.9\u0026thinsp;\u0026plusmn;\u0026thinsp;25.0) ml) and postoperative bleeding (51.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.4 vs 112.9\u0026thinsp;\u0026plusmn;\u0026thinsp;36.2ml) of patients in the minimally invasive group was significantly lower than that in the traditional group, respectively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe minimally invasive treatment of grade I and grade II GMC with a self-made special cutter combined with a special compression hemostatic device can achieve favorable clinical outcomes. Additionally, it causes less trauma, simplifies the operation, reduces intraoperative and postoperative bleeding, allows for early functional exercise, and promotes rapid functional recovery. Therefore, this treatment is worthy of clinical application.\u003c/p\u003e","manuscriptTitle":"Minimally invasive treatment of grade I and II gluteal muscle contracture using a self-made special cutter combined with a specialized compression hemostasis device","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 18:22:32","doi":"10.21203/rs.3.rs-4571213/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-15T14:49:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-15T04:37:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-19T16:36:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34834366452195166281673206436820207918","date":"2024-10-14T18:11:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305815335901282348274427919462673039176","date":"2024-09-24T18:19:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311495707705532983554905706417996962188","date":"2024-07-26T23:55:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-14T05:44:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102367209979787143421477910946490050245","date":"2024-06-25T15:40:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25414156660081004963649338272988121151","date":"2024-06-24T00:02:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-23T00:18:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-20T18:28:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-20T11:07:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-20T11:07:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2024-06-12T15:09:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8de982ff-066d-4eb5-af00-18cc37672118","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T16:09:24+00:00","versionOfRecord":{"articleIdentity":"rs-4571213","link":"https://doi.org/10.1186/s12891-024-08150-1","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2024-12-19 15:58:37","publishedOnDateReadable":"December 19th, 2024"},"versionCreatedAt":"2024-07-18 18:22:32","video":"","vorDoi":"10.1186/s12891-024-08150-1","vorDoiUrl":"https://doi.org/10.1186/s12891-024-08150-1","workflowStages":[]},"version":"v1","identity":"rs-4571213","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4571213","identity":"rs-4571213","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}