de Morais Filho Mauro C, Neves Daniella Lins, Abreu Fábio Peluzo, Juliano Yara, Guimarães Leandro
Department of Pediatric Orthopaedic, AACD, São Paulo, Brazil,
J Child Orthop. 2008 Feb;2(1):37-43. doi: 10.1007/s11832-007-0073-x. Epub 2008 Jan 3.
The purpose of this study was to evaluate the results of distal femur extension osteotomy and medial hamstring lengthening in the treatment of fixed knee flexion deformity in patients with spastic diparetic cerebral palsy.
A retrospective study was done in a group of 12 diparetic cerebral palsy patients. A distal femur extension osteotomy was performed as part of multilevel surgery on lower limbs. The fixed knee flexion deformity was measured during physical examination, whereas hip and knee flexion in the stance phase and anterior pelvic tilt were both analyzed at kinematics. The pre- and post-surgery results were compared and analyzed statistically. A medical record review was done in order to identify the complications. The mean follow-up was 28 months.
A significant reduction of fixed knee flexion deformity at physical examination and knee flexion in the stance phase at kinematics was observed, but with no decrease in hip flexion. As a non-desired effect, there was an increase in anterior pelvic tilt after surgical procedures. With regard to complications, a single patient had skin breakdown at a calcaneous area on one side and the recurrence of deformity was seen in 27% of cases.
In this study, in which fixed knee flexion deformity did not exceed 40 degrees before surgery, the distal femur extension osteotomy was effective in increasing knee extension in the stance phase. However, an increase in anterior pelvic tilt, deformity recurrence and necessity for walking aids are possible complications of this procedure.
本研究旨在评估股骨远端伸展截骨术和半腱肌内侧延长术治疗痉挛性双侧瘫脑瘫患者固定性膝关节屈曲畸形的效果。
对一组12例双侧瘫脑瘫患者进行回顾性研究。股骨远端伸展截骨术作为下肢多级手术的一部分进行。体格检查时测量固定性膝关节屈曲畸形，而在运动学上分析站立期的髋部和膝关节屈曲以及骨盆前倾情况。对手术前后的结果进行比较并进行统计学分析。查阅病历以确定并发症。平均随访时间为28个月。
体格检查时固定性膝关节屈曲畸形以及运动学上站立期膝关节屈曲均有显著降低，但髋部屈曲无减少。作为不良影响，手术后骨盆前倾增加。关于并发症，1例患者一侧跟骨区域出现皮肤破损，27%的病例出现畸形复发。
在本研究中，术前固定性膝关节屈曲畸形未超过40度，股骨远端伸展截骨术在增加站立期膝关节伸展方面有效。然而，骨盆前倾增加、畸形复发以及需要助行器是该手术可能的并发症。
