Thomas B, Schopler S, Wood W, Oppenheim W L
Clin Orthop Relat Res. 1985 Apr(194):87-92.
Of 104 patients with arthrogryposis multiplex congenita treated between 1952 and 1982, 74 had significant knee contractures, instability, or recurvatum. The minimum follow-up period was two years. Nonoperative treatment modalities included physical therapy, bracing, and serial casting in 43 patients (78 knees). Thirty-one other patients (46 knees) had 62 operative procedures, including hamstring and posterior capsular release, epiphysiodesis, distal femoral or proximal tibial osteotomy, arthrodesis, and knee disarticulation. Surgery was reserved for the more resistant causes and was recommended only as part of an overall treatment plan including the correction of foot and hip deformities. The average follow-up period for the surgically treated patients was 11 years, with a range of two to 20 years. Recurrence of deformity was frequent, with no one procedure being clearly favored. Physiotherapy alone rarely resulted in clinically significant improvement unless accompanied by prolonged casting and bracing. The most useful surgical procedure in the growing child was posterior capsular release performed in conjunction with hamstring tenotomy. Contractures treated by osteotomies before the completion of growth had a high rate of recurrence.
在1952年至1982年间接受治疗的104例先天性多发性关节挛缩症患者中，74例存在明显的膝关节挛缩、不稳定或膝反屈。最短随访期为两年。43例患者（78个膝关节）采用了非手术治疗方法，包括物理治疗、支具固定和系列石膏固定。另外31例患者（46个膝关节）接受了62次手术，包括腘绳肌和后关节囊松解、骨骺阻滞、股骨远端或胫骨近端截骨、关节融合和膝关节离断。手术仅用于治疗较顽固的病因，并且仅作为包括足部和髋部畸形矫正在内的整体治疗计划的一部分。接受手术治疗患者的平均随访期为11年，范围为2至20年。畸形复发很常见，没有一种手术方法明显更具优势。除非同时进行长时间的石膏固定和支具固定，单纯物理治疗很少能带来临床上显著的改善。对于正在生长的儿童，最有效的手术方法是后关节囊松解联合腘绳肌切断术。在生长完成前通过截骨术治疗的挛缩复发率很高。
