昆格尔石膏固定法治疗小儿膝关节屈曲挛缩：一项长达26年的单机构经验。

Wiley Marcel R, Riccio Anthony I, Felton Kevin, Rodgers Jennifer A, Wimberly Robert L, Johnston Charles E

*Department of Orthopedic Surgery, The University of Texas Southwestern Medical Center at Dallas †Texas Scottish Rite Hospital for Children, Dallas, TX.

J Pediatr Orthop. 2017 Oct/Nov;37(7):e421-e426. doi: 10.1097/BPO.0000000000001013.

BACKGROUND

Quengel casting was introduced in 1922 for nonsurgical treatment of knee flexion contractures (KFC) associated with hemophilic arthropathy. It consists of an extension-desubluxation hinge fixed to a cast allowing for gradual correction of a flexion deformity while preventing posterior tibial subluxation. The purpose of this study is to report 1 center's experience with this technique for the treatment of pediatric KFC.

METHODS

A retrospective review was conducted over a 26-year period. All patients with KFC treated with Quengel casting were included. Demographic data, associated medical conditions, adjunctive soft tissue releases, complications, and the need for late surgical intervention were recorded. Tibiofemoral angle measurements in maximal extension were recorded at initiation and termination of casting, 1-year follow-up, and final follow-up. Success was defined as no symptomatic recurrence of KFC or need for subsequent surgery.

RESULTS

Eighteen patients (26 knees) were treated for KFC with Quengel casting. Average age at initiation of casting was 8.1 years with average follow-up of 59.9 months. Fifteen knees (58%) underwent soft tissue releases before casting. An average of 1.5 casts per knee were applied over an average of 23.9 days. Average KFC before casting was 50.6 degrees (range, 15 to 100 degrees) which improved to 5.96 degrees (0 to 40 degrees) at cast removal (P<0.00001). Sixteen patients (22 knees) had 1-year follow-up or failed casting before 1 year. Of these, 11 knees (50%) had a successful outcome. Residual KFC of those treated successfully was 6.8 degrees (range, 0 to 30 degrees) at 1 year and 8.2 degrees (range, 0 to 30 degrees) at final follow-up, averaging 71.4 months (P=0.81). Of the 11 knees deemed failures, all had recurrence of deformity within an average of 1 year from cast removal. Surgical release before Quengel casting did not improve the chances for success (P=0.09).

CONCLUSIONS

Quengel casting can improve pediatric KFC an average of 44.2 degrees with minimal complications. Although 50% of treated patients will demonstrate significant recurrence or need later surgery, the majority of those treated successfully have durable results at intermediate term follow-up.

LEVEL OF EVIDENCE

Level IV-therapeutic study.

背景

1922年引入了昆格尔石膏固定法，用于非手术治疗与血友病性关节病相关的膝关节屈曲挛缩（KFC）。它由一个固定在石膏上的伸展-半脱位铰链组成，可在防止胫骨后脱位的同时逐渐纠正屈曲畸形。本研究的目的是报告一家中心使用该技术治疗儿童KFC的经验。

方法

进行了一项为期26年的回顾性研究。纳入所有接受昆格尔石膏固定法治疗的KFC患者。记录人口统计学数据、相关医疗状况、辅助软组织松解、并发症以及后期手术干预的必要性。在石膏固定开始和结束时、1年随访以及最终随访时记录最大伸展时的胫股角测量值。成功定义为KFC无症状复发或无需后续手术。

结果

18例患者（26个膝关节）接受了昆格尔石膏固定法治疗KFC。石膏固定开始时的平均年龄为8.1岁，平均随访59.9个月。15个膝关节（58%）在石膏固定前进行了软组织松解。每个膝关节平均应用1.5个石膏，平均持续23.9天。石膏固定前KFC的平均度数为50.6度（范围为15至100度），拆除石膏时改善至5.96度（0至40度）（P<0.00001）。16例患者（22个膝关节）进行了1年随访或在1年内石膏固定失败。其中，11个膝关节（50%）取得了成功结果。成功治疗的患者在1年时的残余KFC为6.8度（范围为0至30度），最终随访时为8.2度（范围为0至30度），平均随访71.4个月（P=0.81）。在11个被视为失败的膝关节中，所有膝关节在拆除石膏后平均1年内均出现畸形复发。昆格尔石膏固定前的手术松解并未提高成功几率（P=0.09）。