骨骺骨膜切除术治疗儿童膝关节畸形22例

Epiphyseal Periosteum Excision in the Treatment of Knee Deformity in children

运用骨骺骨膜切除术治疗22例儿童膝关节畸形,并评价其结果。22例27个膝关节获得性畸形,年龄5～12岁,其中膝反屈18例;膝外翻4例。临床表现严重跛行,膝关节畸形无法代偿并有进一步加重趋势。X 线片表现局部骨骺发育迟缓,且患儿无手术禁忌证,运用骨骺部发育迟缓处骺线上下1mm 以内骨膜切除治疗。经2年3个月随访,1例术后处理欠妥,1例骨膜切除范围不足,经再次切除骨膜,其余膝关节畸形一次手术矫正,且无新的畸形出现。骨膜切除术,解除了骨骺部生长约束力,刺激快长,可作为儿童膝关节畸形矫正的一种方法。

Objective:To introduce the method of epiphyseal perios excision in the treatment of knee deformity in children.Method:From 1992 on,22 cases of acquired knee deformity(27 knees)have bean treated by semi-circumferential periosteum excision.The age ranged from 5-12 years with an average of 7 yrs and 8 mos.Of them,18 were genu recurvatum(poliomyelitis 17, cerebral palsy 1),and 4 were genu valgum(rickets 1,complicated by osteotomy 3).The patients presented with severe lameness and progressive deformities.X-ray film showed partial retardation of physeal development.Semi-circumferential periost excision extending 1mm superior and 1mm inferior to the involved part of the physis was adopted.Results:A follow-up of 2yrs and 3mos in average revealed that the deformities were corrected without recurrence except two failed in insuf- ficient exision.Conclusion:The partial epiphysis periosteum excision can stimulate the local growth by eliminating the limitation of growth plate.It can be used as a method to treat knee de- formity in children.