Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2012 Dec;20(12):2413-8. doi: 10.1007/s00167-012-1915-8. Epub 2012 Feb 4.
The treatment of fixed knee flexion deformity through anterior distal femoral stapling has been investigated in only two studies so far, with promising results. The aim of the present study was to determine whether this technique might improve fixed knee flexion deformity in a series of growing children and adolescents with different conditions. Follow-up examinations were continued after staple removal in terms of a possible impairment of this deformity.
We reviewed the medical records of all patients with fixed knee flexion deformity who had been treated by anterior distal femoral stapling at our institution. Twenty patients (37 knees) with a mean age of 12.7 years met the inclusion criteria (>12 months of follow-up; no additional procedures to correct fixed knee flexion deformity such as hamstring lengthening or posterior capsulotomy) and were evaluated in this study.
The mean fixed knee flexion deformity significantly improved from 21.4° (SD = 11.6) preoperatively to 7.0° (SD = 9.8) after a mean follow-up of 35.3 months. Young patients (<12 years) revealed superior improvement of this deformity, and especially children with distinct fixed knee flexion deformity of 30° or greater had benefit from early treatment. Impairment of flexion deformity was only seen in one patient (2 knees) after staple removal.
Our results demonstrate that anterior distal femoral stapling is an effective method for the treatment of fixed knee flexion deformity in growing children and adolescents. Rare complications, immediate mobilization, and a low recurrence rate after staple removal provide obvious advantages of this minimally invasive procedure.
Retrospective therapeutic study, Level IV.
目前仅有两项研究探讨了通过股骨远端前侧骨钉固定术治疗膝关节伸直挛缩畸形的疗效，结果均较为理想。本研究旨在评估该技术是否能改善不同病因的生长发育期儿童和青少年膝关节伸直挛缩畸形。在移除骨钉后，我们将继续对膝关节伸直挛缩畸形的恢复情况进行随访，以明确是否存在该畸形的复发。
我们回顾性分析了在我院接受股骨远端前侧骨钉固定术治疗膝关节伸直挛缩畸形的所有患者的病历资料。符合纳入标准的患者共有 20 名（37 膝），平均年龄为 12.7 岁（12 个月以上的随访期；未接受其他手术来矫正膝关节伸直挛缩畸形，如腘绳肌延长术或后关节囊切开术），并在本研究中进行了评估。
患者膝关节伸直挛缩畸形的平均固定角度由术前的 21.4°（标准差 [SD] = 11.6°）显著改善至术后 35.3 个月时的 7.0°（SD = 9.8°）。年轻患者（<12 岁）的膝关节伸直挛缩畸形改善更为显著，尤其是存在 30°以上明确膝关节伸直挛缩畸形的患儿，早期接受治疗获益更多。移除骨钉后，仅有 1 名患者（2 膝）出现膝关节伸直挛缩畸形复发。
我们的研究结果表明，股骨远端前侧骨钉固定术是治疗生长发育期儿童和青少年膝关节伸直挛缩畸形的一种有效方法。该微创手术具有并发症少、术后即刻可活动、移除骨钉后复发率低等明显优势。
回顾性治疗研究，Ⅳ级。
