一种针对先天性膝关节脱位的微创治疗方案。

A minimally invasive treatment protocol for the congenital dislocation of the knee.

作者信息

Shah Nirav R, Limpaphayom Noppachart, Dobbs Matthew B

机构信息

Department of Orthopaedic Surgery, Washington University School of Medicine, One Children's Place, and Saint Louis Shriners Hospital for Children, St. Louis, MO 63110, USA.

出版信息

J Pediatr Orthop. 2009 Oct-Nov;29(7):720-5. doi: 10.1097/BPO.0b013e3181b7694d.

DOI:10.1097/BPO.0b013e3181b7694d

PMID:20104152

Abstract

BACKGROUND

Congenital dislocation of the knee is a rare condition for which the treatment is difficult and remains controversial. For severe cases associated with neuromuscular disorders treatment has usually consisted of extensive surgical reconstruction. The purpose of this study is to assess the short-term results of a new method of treatment for this patient population that involves casting and less extensive surgery.

METHODS

We retrospectively reviewed the cases of 8 consecutive patients, 4 girls and 4 boys, with 16 congenitally dislocated knees that had been diagnosed and treated by a single surgeon with a new minimally invasive treatment protocol. Treatment consisted of serial casting followed by a mini-open quadriceps tenotomy. The mean age at presentation was 5.3 weeks (range, 1 to 13 wk). The mean follow-up was 33 months (range, 12 to 72 mo). All knees were graded in terms of function at final follow-up.

RESULTS

Serial casting alone was effective in achieving correction in 3 knees. The remaining 13 knees had an average of 7 casts (range, 5 to 9 casts) before surgery. Ten knees were treated with a mini-open quadriceps tenotomy alone and 3 with an additional anterior capsulotomy at the time of the initial surgery. Two knees developed recurrent deformities and required additional surgery. Two knees sustained plastic deformation of the proximal tibia during physical therapy that resolved with time. At final follow-up, knee outcome was excellent in 11 (69%) knees, good in 3 (19%) knees, and fair in 2 (12%) knees.

CONCLUSIONS

The results of our study support the use of a less invasive approach for the initial treatment of congenital dislocation of the knee in this patient population. This approach avoids the complications of extensive scarring and stiffness that often accompany the more invasive surgical treatments. Longer follow-up, however, is necessary to see whether reduction and knee range of motion are maintained.

LEVEL OF EVIDENCE

Level 4 case series.

摘要

背景

先天性膝关节脱位是一种罕见病症，其治疗困难且仍存在争议。对于与神经肌肉疾病相关的严重病例，治疗通常包括广泛的手术重建。本研究的目的是评估一种针对该患者群体的新治疗方法的短期效果，该方法包括石膏固定和范围较小的手术。

方法

我们回顾性分析了连续8例患者（4名女孩和4名男孩）共16个先天性脱位膝关节的病例，这些病例均由同一位外科医生按照一种新的微创治疗方案进行诊断和治疗。治疗包括连续石膏固定，随后进行小切口股四头肌肌腱切断术。就诊时的平均年龄为5.3周（范围为1至13周）。平均随访时间为33个月（范围为12至72个月）。在最终随访时，对所有膝关节的功能进行分级。

结果

仅通过连续石膏固定就使3个膝关节得到有效矫正。其余13个膝关节在手术前平均接受了7次石膏固定（范围为5至9次）。10个膝关节仅接受了小切口股四头肌肌腱切断术治疗，3个膝关节在初次手术时还额外进行了前关节囊切开术。2个膝关节出现复发畸形，需要再次手术。2个膝关节在物理治疗期间出现胫骨近端塑性变形，但随着时间推移得以恢复。在最终随访时，11个（69%）膝关节的结果为优，3个（19%）膝关节为良，2个（12%）膝关节为可。