Parekh P K
Int Orthop. 1983;7(3):165-72. doi: 10.1007/BF00269501.
Contractures of the knee after poliomyelitis are common in children in developing countries and treatment, particularly that of severe contractures, presents a surgical challenge. This paper describes a new method for correcting contractures of the knee. Mild contractures need manipulation only and a plaster cast. Moderate contractures are treated by a partial soft-tissue release of the hamstrings and fascia lata followed by gradual stretching of the remaining soft-tissues by manipulation and plaster. Where the contracture is severe, skeletal traction is used through Steinmans pins inserted into the tibia and os calcis. One hundred and thirty-six knees with varying degrees of contracture were treated by these methods. Full correction was achieved and then maintained by plaster immobilisation, physiotherapy and calipers. This prevented recurrence during an average follow-up period of two and a half years. The severity of the contracture of the knee was in direct proportion to the severity of associated flexion-abduction contractures at the hip and equinus deformity at the ankle, the degree of muscle imbalance. All of the contractures of the hip and some of the ankle (46.8%) needed simultaneous operative correction. The basic method is technically simple, requires no special equipment and the results recommend its use particularly in developing countries.
小儿麻痹症后膝关节挛缩在发展中国家的儿童中很常见，其治疗，尤其是严重挛缩的治疗，是一项外科挑战。本文描述了一种矫正膝关节挛缩的新方法。轻度挛缩仅需手法治疗和石膏固定。中度挛缩通过部分腘绳肌和阔筋膜张肌软组织松解，然后通过手法和石膏逐渐拉伸剩余软组织来治疗。对于严重挛缩，通过插入胫骨和跟骨的斯氏针进行骨牵引。采用这些方法治疗了136个不同程度挛缩的膝关节。通过石膏固定、物理治疗和夹板实现并维持了完全矫正。这在平均两年半的随访期内防止了复发。膝关节挛缩的严重程度与髋关节相关的屈曲外展挛缩和踝关节马蹄畸形的严重程度、肌肉失衡程度成正比。所有髋关节挛缩和部分踝关节挛缩（46.8%）需要同时进行手术矫正。该基本方法技术简单，无需特殊设备，其结果表明该方法尤其适用于发展中国家。
