Oetgen Matthew E, Walick Kristina S, Tulchin Kirsten, Karol Lori A, Johnston Charles E
Texas Scottish Rite Hospital for Children, Dallas, TX, USA.
J Pediatr Orthop. 2010 Apr-May;30(3):216-23. doi: 10.1097/BPO.0b013e3181d48375.
Congenital knee dislocation (CDK) is a rare congenital deformity, which often requires surgery for treatment. Little objective data exist characterizing the outcome of patients who require operative treatment for this condition. The purposes of this study were to objectively evaluate the functional, clinical, and gait outcomes of patients who underwent surgical treatment of CDK; and compare the results of outcome between 2 surgical approaches for this condition: quadricepsplasty and femoral shortening.
We performed a retrospective review of all patients (7) treated surgically for CDK. Patients were evaluated at an average follow-up of 12+6 years. Each patient underwent a clinical examination, functional evaluation using the Lysholm Knee Questionnaire and Pediatric Outcomes Data Collection Instrument, and a 3-dimensional gait evaluation. The results of the total group were compared with normal controls. Additionally, results of the patients treated with quadricepsplasty were compared with patients treated with femoral shortening.
Total knee range of motion for the entire group averaged 112 degrees, with 8 of the 9 knees having flexion>90 degrees. Seven of the 9 knees were found to have some degree of instability on examination, yet none of the patients reported using any form of brace for ambulation. Functional evaluation showed good knee specific and overall function, comparable to normal controls. There were no differences in clinical or functional outcomes between the 2 surgical approaches. Gait analysis revealed a stiff-knee gait pattern to the congenital knee dislocation group, as compared with normal controls, and subtle differences in knee function between the surgical approaches.
The function of patients after surgical treatment for CDK seems to be quite good compared with normal controls. Good knee specific and overall function scores are reported with limitations seen only in higher demand activities. Despite instability of the knee noticed on clinical examination, patients ambulate without braces and have a functional knee range of motion. Little difference in outcome was seen between the 2 surgical approaches used to treat this condition.
Therapeutic Study, Level III.
先天性膝关节脱位（CDK）是一种罕见的先天性畸形，通常需要手术治疗。目前几乎没有客观数据来描述需要手术治疗这种疾病的患者的治疗结果。本研究的目的是客观评估接受CDK手术治疗的患者的功能、临床和步态结果；并比较针对这种疾病的两种手术方法（股四头肌成形术和股骨缩短术）的结果。
我们对所有接受CDK手术治疗的患者（7例）进行了回顾性研究。患者的平均随访时间为12 + 6年。每位患者均接受了临床检查、使用Lysholm膝关节问卷和儿科结局数据收集工具进行的功能评估以及三维步态评估。将整个组的结果与正常对照组进行比较。此外，将接受股四头肌成形术治疗的患者结果与接受股骨缩短术治疗的患者结果进行比较。
整个组的膝关节总活动范围平均为112度，9个膝关节中有8个屈曲大于90度。检查发现9个膝关节中有7个存在一定程度的不稳定，但没有患者报告在行走时使用任何形式的支具。功能评估显示膝关节特定功能和整体功能良好，与正常对照组相当。两种手术方法在临床或功能结果上没有差异。步态分析显示，与正常对照组相比，先天性膝关节脱位组存在膝关节僵硬步态模式，且两种手术方法在膝关节功能上存在细微差异。
与正常对照组相比，CDK手术治疗后患者的功能似乎相当良好。报告显示膝关节特定功能和整体功能评分良好，仅在对活动要求较高的情况下存在局限性。尽管临床检查发现膝关节不稳定，但患者无需支具行走，膝关节活动范围功能良好。用于治疗这种疾病的两种手术方法在结果上差异不大。
治疗性研究，III级。
