Cipriano Cara, Keenan Mary Ann E
Neuro-Orthopaedics Service, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Clin Orthop Relat Res. 2007 Sep;462:150-5. doi: 10.1097/BLO.0b013e3180ca8e96.
Severe lower extremity contractures cause many problems for patients and their caregivers. Hygiene, skin and perineal care, positioning, and dressing are severely compromised. Surgical management of such deformities is challenging and results have not been published. We treated eight nonambulatory adults with severe and rigid lower extremity contractures with hip release and knee disarticulation of 14 extremities. The patients had neurologic disorders with spasticity. The indications for surgery were fixed contractures of at least 90 degrees at the knee and hip that interfered with passive function and quality of life. All patients were bed-bound secondary to their contractures. The average age at surgery was 57 years; the minimum followup was 6 months (mean, 34 months; range, 6-102 months). The average preoperative flexion contractures were 106 degrees at the hips and 139 degrees at the knees. The average postoperative hip flexion contracture was 6 degrees , and there were no serious complications or recurrent contractures. Positioning and hygiene problems were universally improved, enabling all of the patients to become wheel-chair users, and all patients or their caretakers reported resolution of pain.
严重的下肢挛缩给患者及其护理人员带来诸多问题。卫生、皮肤及会阴护理、体位摆放和穿衣等方面都受到严重影响。此类畸形的手术治疗颇具挑战性，且相关结果尚未发表。我们对8例非行走型成年患者的14条下肢进行了髋关节松解和膝关节离断术，以治疗严重且僵硬的下肢挛缩。这些患者患有伴有痉挛的神经系统疾病。手术指征为膝关节和髋关节至少90度的固定挛缩，这妨碍了被动功能和生活质量。所有患者因挛缩而卧床不起。手术时的平均年龄为57岁；最短随访时间为6个月（平均34个月；范围6 - 102个月）。术前髋关节平均屈曲挛缩为106度，膝关节为139度。术后髋关节平均屈曲挛缩为6度，且无严重并发症或挛缩复发。体位摆放和卫生问题普遍得到改善，使所有患者都能使用轮椅，所有患者或其护理人员均报告疼痛得到缓解。
