Simonian P T, Staheli L T
Department of Orthopaedic Surgery, Children's Hospital and Medical Center, University of Washington, Seattle 98195, USA.
J Pediatr Orthop. 1995 May-Jun;15(3):288-91. doi: 10.1097/01241398-199505000-00004.
We report two cases, each of which sustained two separate periarticular fractures from overzealous manipulation for knee contracture. The four fractures reported in this study involve one normal child sustaining asynchronous ipsilateral distal femoral and proximal tibial fractures and a child with the diagnosis of amyoplasia sustaining bilateral proximal tibial fractures. The child with knee contracture must be treated carefully and not exposed to overzealous physiotherapy or manipulation. The child who has developed a joint contracture secondary to lengthy immobilization may be at increased risk for periarticular fracture secondary to disuse osteopenia. The knee joint is at particular risk because of the long lever arm of the leg. These concerns should be conveyed to anyone involved in the patient's care, including the parents, therapists, nurses, and physicians. Passive range of motion in the child should never be painful. Normal children often can obtain maximal range of motion if left alone and not restricted.
我们报告了两例病例，每例均因过度用力手法治疗膝关节挛缩而导致两处不同的关节周围骨折。本研究报告的这四处骨折，其中一例是一名正常儿童发生了不同步的同侧股骨远端和胫骨近端骨折，另一例是一名被诊断为先天性肌发育不全的儿童发生了双侧胫骨近端骨折。患有膝关节挛缩的儿童必须谨慎治疗，避免接受过度的物理治疗或手法操作。因长期固定而继发关节挛缩的儿童，可能因废用性骨质减少而面临关节周围骨折风险增加。由于腿部杠杆臂较长，膝关节尤其危险。这些问题应告知参与患儿护理的每一个人，包括家长、治疗师、护士和医生。儿童被动活动范围绝不应引起疼痛。正常儿童如果不被限制且任其自行活动，通常能够获得最大活动范围。
