目的 探讨非手术的物理疗法以及手术治疗重度臀肌挛缩症的适应证和方法，提出该病 的分级，分析分级的必要性和意义。方法 根据制定的臀肌挛缩症的分级标准，将210名患者按病情轻 重程度分为Ⅰ、Ⅱ、Ⅲ度。Ⅰ度采用非手术的物理疗法治疗；Ⅱ度及Ⅲ度患者全部采用经大转子内上方 斜形小切口手术治疗。Ⅱ度患者手术彻底松解紧张纤维化的臀肌及挛缩增厚的阔筋膜；Ⅲ度患者手术 松解必须深达髋关节囊，斜行切开关节囊后上方，行关节囊成形术。术后早期进行积极的并膝屈髋功能 锻炼，防止粘连。结果 Ⅰ度患者23例，经理疗、按摩治疗，所有症状均有不同程度减轻，有效率为 (100%，优良率为39%；Ⅱ、Ⅲ度患者187例，全部行手术治疗，优良率达97%。结论 将臀肌挛缩症进行 分级，更有利于准确的区别该病的轻重程度和选择相应的治疗方法。非手术疗法治疗臀肌挛缩症有一 定的疗效，主要适用于Ⅰ度患者；手术治疗适用于Ⅱ、Ⅲ度患者，疗效满意。

目的 探讨部分腓骨切除后对儿童供侧肢体功能及形态的影响。方法 对3～12岁患原发性腓骨近端骨巨细胞瘤、胫骨骨折骨缺损及股骨头坏死的儿童共63例，经小腿前外侧入路 行部分带血管腓骨切取术。术后随访3～10年，用踝关节功能测定仪、运动负荷试验、胫腓骨及踝 关节x线片测量及评价双侧肢体功能及形态。结果 无一例肢体发育障碍或发生坏死。腓深神经 或腓浅神经损伤占11%，但多数在术后3月内自行恢复，仅2例留有持久腓浅神经损伤表现。做运 动负荷试验后检查30例病人中2例轻度踝疼，1例有较明显的踝疼。随患儿身高的增加，供骨侧腓 骨远近两残端逐渐增长，但缺损司隙不变。结论 儿童部分腓骨被切除以后，多数供侧肢体无严重 并发症。30例中有3例踝部疼痛者与腓骨切除较长有关。远期腓骨缺损司隙相对变短，这有利于 儿童晚期供骨侧踝关节的稳定性。

superficial peroneal nerve in 7. Symptomsresolved spontaneously at 3 to 5 months in 6, butpersisted in 2 patients in the latter group at 8 years’ follow-up.Of 24 children who underwent rapid walking (200 m) followedby immediate stair climbing (50 steps), 2 (whose graftswere longer than average) had slight and 1 had obvious anklepain. However, muscle strength and range of motion in thedonor ankle were no different from values in the recipient legin the 24 cases. X-ray findings showed that, with growth, theremaining 2 fibular segments in the donor leg became longer,but the length of the gap between did not change. Thus, thegap left by harvest became relatively shorter long after operation,benefiting the stability of the ankle joint in adulthood.Conclusion: Unlike free vascularized fibula grafts performedin adulthood, from which serious complications to the donorleg have been reported, the procedure performed in childhoodappears not to have an adverse effect on functionaldevelopment.