Khakharia Saurabh, Fragomen Austin T, Rozbruch S Robert
Institute for Limb Lengthening and Reconstruction, Limb Lengthening and Deformity Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
Clin Orthop Relat Res. 2009 Nov;467(11):2911-7. doi: 10.1007/s11999-009-0951-2. Epub 2009 Jun 25.
Extension contracture of the knee is a common complication of femoral lengthening. Knee flexion exercises to stretch the contracture with physical therapy can be effective but take a prolonged amount of time to work and place increased stress across the patellofemoral joint. We developed a minimal-incision limited quadricepsplasty surgical technique to treat knee extension contracture secondary to femoral lengthening and retrospectively reviewed 16 patients treated with this procedure. The mean age of the patients was 23 years. Range of motion of the knee and quadriceps strength were recorded preoperatively, after femur lengthening but before additional surgery, after quadricepsplasty, and at each followup. The mean femoral lengthening performed was 4.4 cm. We compared range of motion and time to regain knee flexion with those of historical controls. The minimum followup after quadricepsplasty was 6 months (mean, 38 months; range, 6-84 months). The mean range of motion was 129 degrees preoperatively, 29 degrees after the distraction phase of femoral lengthening, and 108 degrees after limited quadricepsplasty, and at final followup, the mean knee flexion was 125 degrees . There were no major complications. Limited quadricepsplasty improved knee flexion after a knee extension contracture developed secondary to femoral lengthening. In comparison to historical controls who did not have quadricepsplasty, the patients with limited quadricepsplasty had quicker return of knee flexion, although there was no difference in knee flexion achieved ultimately.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
膝关节伸直挛缩是股骨延长术常见的并发症。通过物理治疗进行膝关节屈曲练习以拉伸挛缩可能有效，但起效时间长，且会增加髌股关节的应力。我们开发了一种小切口有限股四头肌成形术的手术技术来治疗股骨延长术后继发的膝关节伸直挛缩，并对16例行该手术的患者进行了回顾性研究。患者的平均年龄为23岁。记录术前、股骨延长后但在进一步手术前、股四头肌成形术后以及每次随访时的膝关节活动范围和股四头肌力量。平均股骨延长长度为4.4厘米。我们将膝关节活动范围和恢复膝关节屈曲的时间与历史对照进行了比较。股四头肌成形术后的最短随访时间为6个月（平均38个月；范围6 - 84个月）。术前平均活动范围为129度，股骨延长牵张期后为29度，有限股四头肌成形术后为108度，最终随访时，平均膝关节屈曲度为125度。无重大并发症。有限股四头肌成形术改善了股骨延长术后继发膝关节伸直挛缩患者的膝关节屈曲。与未行股四头肌成形术的历史对照相比，有限股四头肌成形术患者的膝关节屈曲恢复更快，尽管最终达到的膝关节屈曲度没有差异。
III级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
