Woratanarat Patarawan, Dabney Kirk W, Miller Freeman
Mahidol Universitesiniversitesi Tip Fakültesi Ramathibodi Hastanesi Ortopedi Kliniği, Bangkok, Tayland.
Acta Orthop Traumatol Turc. 2009 Mar-Apr;43(2):121-7. doi: 10.3944/AOTT.2009.121.
This study aimed to assess the results of knee capsulotomy for correcting fixed knee flexion contracture in children with cerebral palsy (CP).
Thirty-five children (20 boys, 15 girls; mean age 13.5+/-2.5 years) with CP underwent posterior knee capsulotomy for 59 knees. Eleven patients had diplegia, one patient had hemiplegia, and 23 patients had quadriplegia. There were two community ambulators (3 knees), 19 household ambulators (33 knees), and 14 nonambulators (23 knees). Posterior knee capsulotomy was combined with hamstring lengthening (50 knees, 84.8%), rectus femoris transfer (10 knees, 17%), Achilles tendon lengthening (12 knees, 20.3%), and posterior cruciate ligament release (eight knees, 13.6%). The mean follow-up was 3.5+/-1.7 years.
Fixed knee flexion contracture significantly improved from 26.5+/-15.4 degrees to 17.0+/-15.5 degrees after posterior knee capsulotomy (p<0.0001). The mean improvement was 9.5 degrees. Popliteal angle significantly improved from 70.6+/-18.7 degrees to 48.2+/-19.9 degrees (p<0.0001). Ankle dorsiflexion did not differ significantly. At the end of follow-up, 38 knees (64.4%) had improved knee flexion contracture and 21 knees (35.6%) had recurrent flexion contracture (failure). Age and male gender were significantly associated with failure rate (adjusted odds ratio 0.78, 95% CI: 0.62-0.99 and 12.1, 95% CI: 2.37-61.7, respectively). Complications included transient sciatic nerve palsy in seven knees (11.9%), and wound dehiscence in two knees (3.4%). Revision was required in two knees (3.4%), and posterolateral corner reconstruction in one knee (1.7%).
Posterior knee capsulotomy is another option for the treatment of knee contracture in CP, resulting in a significant decrease in knee contracture with acceptable complications. However, failure rate is higher in boys, patients who are marginal ambulators, and in younger age group.
本研究旨在评估膝关节囊切开术矫正脑瘫（CP）患儿固定性膝关节屈曲挛缩的效果。
35例患有CP的儿童（20例男孩，15例女孩；平均年龄13.5±2.5岁）的59个膝关节接受了后膝关节囊切开术。11例为双瘫，1例为偏瘫，23例为四肢瘫。有2例社区步行者（3个膝关节），19例家庭步行者（33个膝关节），14例非步行者（23个膝关节）。后膝关节囊切开术联合了腘绳肌延长术（50个膝关节，84.8%）、股直肌转移术（10个膝关节，17%）、跟腱延长术（12个膝关节，20.3%）和后交叉韧带松解术（8个膝关节，13.6%）。平均随访时间为3.5±1.7年。
后膝关节囊切开术后，固定性膝关节屈曲挛缩从26.5±15.4度显著改善至17.0±15.5度（p<0.0001）。平均改善幅度为9.5度。腘窝角从70.6±18.7度显著改善至48.2±19.9度（p<0.0001）。踝关节背屈无显著差异。随访结束时，38个膝关节（64.4%）的膝关节屈曲挛缩得到改善，21个膝关节（35.6%）出现复发性屈曲挛缩（治疗失败）。年龄和男性性别与失败率显著相关（校正比值比分别为0.78，95%可信区间：0.62 - 0.99和12.1，95%可信区间：2.37 - 61.7）。并发症包括7个膝关节（11.9%）出现短暂性坐骨神经麻痹，2个膝关节（3.4%）出现伤口裂开。2个膝关节（3.4%）需要翻修，1个膝关节（1.7%）需要进行后外侧角重建。
后膝关节囊切开术是治疗CP患儿膝关节挛缩的另一种选择，可使膝关节挛缩显著减轻，并发症可接受。然而，男孩、边缘性步行者以及年龄较小的患儿失败率较高。
