股骨髁上截骨矫形坚强内固定治疗成人膝关节屈曲畸形

Treatment of flexion deformity of the knee joint in adult patients with supracondylar femoral osteotomy and internal fixation

[目的]探讨采用股骨髁上截骨矫形结合坚强内固定治疗成人膝关节屈曲畸形的方法和有效性。[方法]自2002年4月～2008年8月行股骨髁上楔形截骨矫形内固定和早期功能练习治疗脊髓灰质炎后遗膝关节屈曲畸形127例141膝。其中男56例62膝,女71例79膝;平均年龄为18.3岁(14～45岁)。压腿行走83例,扶单拐行走35例,扶双拐行走9例;术前、术后拍摄负重位双膝关节正侧位片及双下肢全长像,测量膝关节屈曲度并进行比较。术后观察手术并发症,随访了解骨愈合情况、膝屈曲畸形角度的变化和膝关节活动度。[结果]所有患者术后经过顺利,无血管神经损伤等并发症。术后随访1～6年,平均随访时间为1.5年。所有127例141膝随访时截骨端获得骨性愈合,无1例骨不愈合、畸形愈合和内固定失败。膝屈曲畸形均得到矫正,屈曲角度由术前的36.4°(18°～61°)矫正到术后的2.8°(-5°～8°),平均矫正32.9°(18°～56°)。末次随访时能自行(或在支具辅助下)行走108例,压腿行走6例,扶单拐行走10例,扶双拐行走3例;膝关节伸屈活动自如,无1例膝关节僵直发生。[结论]股骨髁上截骨矫形结合坚强内固定,术后早期行膝关节功能锻炼,是一种安全、有效的治疗成人膝屈曲畸形的方法。

[Objective] To investigate the results and to evaluate the validity of the supracondylar femoral osteotomy and internal fixation for treatment of flexion deformity of the knee joint in adult polio patients.[Methods]From April 2002 to August 2008,141 knees in 127 cases with flexion deformity of knee from poliomyelitis were treated with supracondylar femoral extension osteotomy and internal fixation.They were 1445 years old with an average of 18.3.Of them,62 knees in 56 cases were male,79 knees in 71 cases were female.Eighty-three cases needed pressing knee on walking.Thirty-five cases walked with a crutch and 9 cases walked with two crutches.It should be treated with soft tissue release and skeletal traction before osteotomy in severe flexion deformity（over 40 degrees）.All cases took weight-bearing X-ray films of lower extremities before and after operation.Angle of knee flexion,operative complications,bone healing and final function were recorded.Patients can undertake continuous passive flexion and extension motion from the 2nd day postoperatively.The knee operated was put in 1020° flexion after operation and extended to full extension gradually in 2 weeks.[Results]All patients felt comfortable after operation and no neurovscular complications and infection happened.Follow-up time was 12-72 months with an average of 18 months.Solid bone union showed in all femoral cutting ends.No mal-union,non-union and implant failure happened.All flexion deformities of knees were corrected.The angle of flexion contracture of knee was from 36.4°（18°～61°）preoperatively to 2.8°（-5°～8°）postoperatively.The amount of correction was 18°to 56°with an average of 32.9°.One hundred and eight patients can walk stably by hinself or with brace,19 cases still need some help for walking（pressing knee in 6 case,one crutch in 10 cases and two crutches in 3 cases）at last follow-up.No ankylosis of knee joint or peroneal nerve paralysis occurred.All cases were satisfying with their range of motion of knee.[Conclusion]Supracondylar femoral osteotomy and rigid internal fixation and early rehabilitation exercise is a safe and effective strategy for the adult flexion deformity of knee joint.