Christini D, Levy E J, Facanha F A, Kumar S J
Alfred I. duPont Institute, Wilmington, DE 19899.
J Pediatr Orthop. 1993 May-Jun;13(3):378-81. doi: 10.1097/01241398-199305000-00020.
Twelve patients (13 extremities) who had complete congenital absence of the tibia were treated between 1963 and 1989. Three patients (three extremities) had a knee disarticulation performed as the primary procedure because they had no quadriceps function. Nine patients (10 extremities) underwent centralization of fibula under the femoral condyles (Brown procedure). Four of these 10 extremities developed a severe flexion contracture of the knee (> 25 degrees) and underwent subsequent knee disarticulation. One patient with a short stump secondary to an ipsilateral proximal femoral focal deficiency had a femorofibular arthrodesis. Five of these 10 extremities had a satisfactory result when reviewed at an average follow-up of 18 years. The patients were evaluated in reference to gait, range of motion (ROM) of the knee, quadriceps strength, prosthetic needs, and peer group sports activities. A strong quadriceps (> grade 4) was noted in all five patients who had a satisfactory result. Flexion contracture of the knee, when < 25 degrees, did not compromise the result.
1963年至1989年间，对12例（13个肢体）先天性胫骨完全缺如的患者进行了治疗。3例患者（3个肢体）因无股四头肌功能，首次手术行膝关节离断术。9例患者（10个肢体）接受了腓骨在股骨髁下的中心化手术（布朗手术）。这10个肢体中有4个出现了严重的膝关节屈曲挛缩（>25度），随后接受了膝关节离断术。1例因同侧近端股骨局部缺损导致残端短的患者行了股腓关节融合术。这10个肢体中有5个在平均18年的随访中结果满意。对患者进行了步态、膝关节活动范围（ROM）、股四头肌力量、假肢需求和同龄人体育活动方面的评估。结果满意的所有5例患者均有强大的股四头肌（>4级）。膝关节屈曲挛缩<25度时，不影响结果。
