Hosny Gamal Ahmed, Fadel Mohamed
Benha Faculty of Medicine, 53, Misr Helwan Agricultural Street, Maadi, Cairo, Egypt.
Clin Orthop Relat Res. 2008 Dec;466(12):2995-3002. doi: 10.1007/s11999-008-0530-y. Epub 2008 Oct 7.
Knee flexion deformity can cause marked physical disability. Acute correction, whether nonoperative or operative, may lead to serious complications. We treated 50 patients (71 knees) between 1994 and 2002 with the Ilizarov external fixator. The deformity was gradually corrected using Ilizarov principles. Of the 50 patients, 29 were affected unilaterally and 21 bilaterally. In 15 patients, there were associated deformities. In no patient did we surgically release soft tissues; in two patients with arthrodesed or congenitally fused knees, we performed osteotomy before distraction. All patients were assessed clinically and radiographically. We assessed knee flexion angle, range of motion, stability, presence of pain, and healing index. After a minimum followup of 1 year (mean 3.7 years; range, 1-8 years), 18 of 20 of the preoperatively nonambulatory patients having bilateral surgery could walk at last followup. Complications included pin tract infection in all patients, knee subluxation in three patients, and fracture related to treatment in seven patients. We believe gradual correction using a circular frame an effective method to treat flexion knee contractures. In patients with bilateral deformities, improvement in functional activity may be expected in most patients.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
膝关节屈曲畸形可导致明显的身体残疾。急性矫正，无论是非手术还是手术矫正，都可能导致严重并发症。1994年至2002年期间，我们使用Ilizarov外固定器治疗了50例患者（71个膝关节）。采用Ilizarov原则逐渐矫正畸形。50例患者中，29例为单侧受累，21例为双侧受累。15例患者存在合并畸形。我们没有对任何患者进行软组织手术松解；对于2例膝关节已融合或先天性融合的患者，我们在牵张之前进行了截骨术。所有患者均进行了临床和影像学评估。我们评估了膝关节屈曲角度、活动范围、稳定性、疼痛情况和愈合指数。在至少随访1年（平均3.7年；范围1 - 8年）后，术前不能行走的20例接受双侧手术的患者中，有18例在末次随访时能够行走。并发症包括所有患者均出现的针道感染、3例患者出现的膝关节半脱位以及7例患者出现的与治疗相关的骨折。我们认为使用环形外固定架逐渐矫正畸形是治疗膝关节屈曲挛缩的有效方法。对于双侧畸形患者，大多数患者的功能活动有望得到改善。
IV级，治疗性研究。有关证据水平的完整描述，请参见《作者指南》。
