Pontén Eva
Department of Pediatric Orthopaedic Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 171 76, Stockholm, Sweden.
J Child Orthop. 2015 Dec;9(6):465-72. doi: 10.1007/s11832-015-0695-3. Epub 2015 Oct 26.
Arthrogryposis is defined as limited range of motion in three or more joints in two or more body parts. This article will describe treatment options for the arthrogrypotic knee. In all types of arthrogryposis, and in both extension and flexion deformities, very early treatment is favorable. Just after birth, traction and mobilization followed by serial casting could often greatly improve the range of motion. In the hyperextended knee, surgical lengthening of the extensor apparatus may be needed. Flexion deformities could be improved with temporary physeal arrest of the anterior distal femur by fixing two-hole plates over the physis on both sides of patella. The plates will result in a constrained growth of the anterior physis, and thus a very slow extension of the knee, which will give the nerves and vessels time to adjust. Pterygium, webbing of the knee joint, is a special subgroup that in selected mild cases could be treated with extensive surgical release of the webbing and orthotics. Arthrogrypotic knees can be treated with early reduction and maintenance with orthotics.
先天性多发性关节挛缩症的定义是两个或更多身体部位的三个或更多关节活动范围受限。本文将描述先天性多发性关节挛缩症膝关节的治疗选择。在所有类型的先天性多发性关节挛缩症中，无论是伸直畸形还是屈曲畸形，早期治疗都是有利的。出生后不久，牵引和活动，随后进行系列石膏固定，通常可以大大改善活动范围。对于膝关节过度伸直的情况，可能需要手术延长伸肌装置。对于屈曲畸形，可以通过在髌骨两侧的骨骺上固定双孔钢板来临时阻止股骨远端前部骨骺的生长，从而改善畸形。钢板将导致前部骨骺生长受限，进而使膝关节非常缓慢地伸直，这将给神经和血管调整的时间。膝关节蹼状畸形是一个特殊的亚组，在某些轻度病例中，可以通过广泛的手术松解蹼状组织和使用矫形器来治疗。先天性多发性关节挛缩症膝关节可以通过早期复位并用矫形器维持治疗。
