Department of Hand Surgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Heidelberg, Germany.
Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, Böheimstraße 37, 72074, Tübingen, Germany.
Arch Orthop Trauma Surg. 2024 May;144(5):2449-2459. doi: 10.1007/s00402-024-05292-8. Epub 2024 Apr 13.
Popliteal pterygium syndrome is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. The popliteal pterygium (PP) affects ambulation due to severe knee flexion contracture and equinovarus deformities. Surgical treatment aims to correct these deformities while preserving limb sensibility. However, due to its rarity, surgical guidelines are lacking.
A meta-analysis according to PRISMA guidelines was conducted to summarize and compare surgical methods for PP. 183 paper were identified in PubMed and data from 32 articles were analyzed, including patient demographics, treatment modalities (Ilizarov fixator, femoral osteotomy, skin/soft tissue procedures, hamstring release, nerve surgery, and amputation), pre- and post-operative abilities to walk, knee joint parameters, complications, and recurrent contractions.
Among 58 patients (87 limbs), Ilizarov fixator demonstrated improved knee and ankle mobility postoperatively, but showed a relatively high surgical session count and complication rates. Femoral osteotomy achieved successful knee posture correction with fewer sessions and no complications. Isolated skin/soft tissue procedures improved flexion contracture and mobility, though they required several procedures. Hamstring release achieved notable contracture reduction but also necessitated multiple interventions. Nerve surgery and amputation had limited data, warranting further investigation.
The management of PP demands a comprehensive approach, considering individual patient characteristics and treatment outcomes. While different surgical modalities offer distinct benefits, a classification or guideline to treat this deformity is still lacking. Further research is essential to validate findings, refine treatment approaches, and enhance the quality of life for individuals with PP.
腘窝翼状胬肉综合征是一种罕见的先天性疾病，其特征为颌面、皮肤、肌肉骨骼和生殖器官异常。腘窝翼状胬肉（PP）会导致严重的膝关节屈曲挛缩和马蹄内翻畸形，从而影响行动能力。手术治疗旨在纠正这些畸形，同时保留肢体感觉。然而，由于其罕见性，目前缺乏手术指南。
按照 PRISMA 指南进行了荟萃分析，以总结和比较 PP 的手术方法。在 PubMed 中确定了 183 篇论文，并对 32 篇文章的数据进行了分析，包括患者人口统计学、治疗方式（伊里扎洛夫固定器、股骨截骨术、皮肤/软组织手术、腘绳肌松解术、神经手术和截肢）、术前和术后行走能力、膝关节参数、并发症和复发挛缩。
在 58 名患者（87 条肢体）中，伊里扎洛夫固定器术后膝关节和踝关节活动度改善，但手术次数和并发症发生率较高。股骨截骨术成功矫正了膝关节姿势，手术次数较少，无并发症。单纯的皮肤/软组织手术改善了屈曲挛缩和活动度，但需要多次手术。腘绳肌松解术可显著减少挛缩，但也需要多次干预。神经手术和截肢的相关数据有限，需要进一步研究。
PP 的管理需要综合考虑患者的个体特征和治疗结果。虽然不同的手术方式有各自的优势，但目前仍缺乏针对这种畸形的分类或治疗指南。进一步的研究对于验证研究结果、完善治疗方法以及提高 PP 患者的生活质量至关重要。
