系列石膏结合矫形器与康复训练治疗大龄儿童先天性膝关节脱位1例

Serial Gypsum Fixation Combined with Orthosis and Rehabilitation Training for Congenital Dislocation of Knee Joint in an Older Child:a Case Report

目的探讨1例大龄儿童先天性双侧膝关节半脱位合并双侧马蹄内翻足、双腕关节屈曲挛缩,应用系列石膏结合矫形器与康复训练的综合康复治疗方法和治疗效果。方法综合康复治疗方法,分为3个阶段:先复位双膝关节并屈曲90°,再矫正双侧马蹄内翻足,最后矫正双腕关节垂腕畸形。在每个阶段中先行手法复位,然后系列石膏固定矫正,穿戴矫形器辅助相应的康复训练。在每个系列石膏阶段结束后,日夜穿戴矫形器维持1年,同时参与日常康复训练。结果患儿双腕关节可以背伸35°,双手握持功能良好。双下肢生物力线正常,双膝关节复位并能屈曲90°,双踝足跖屈、内翻和内旋畸形基本矫正,双下肢可以承重站立及行走。结论先天性膝关节脱位的大龄儿童,应用系列石膏矫正结合矫形器与康复训练等综合治疗方法,仍可能获得较好的治疗效果,可以避免因手术治疗的创伤和痛苦。

Objective To explore the therapeutic effect of serial gypsum fixation combined with orthosis and rehabilitation training on bilateral congenital knee subluxation complicated by bilateral talipes equinovarus and wrist flexion contractures in an older child.Methods The comprehensive rehabilitation was divided into three stages:(1)both knees were restored and flexed to 90 degrees;(2)bilateral talipes equinovarus was corrected;(3)wrist deformity was corrected.In each stage,the child was firstly treated with manual reduction,followed by serial gypsum fixation and orthotic device-assisted rehabilitation training.After the end of each stage of gypsum fixation,the child wore orthotic device day and night for 1 year and received rehabilitation training simultaneously.Results Both wrist joints of the child could dorsiflex 35 degrees and were associated with a good grip function.The biological force line of the lower limbs was normal and both knees were restored and flexed to 90 degrees.The ankle-foot plantarflexion,varus deformity and internal rotation contractures were corrected basically,and the lower limbs could bear the weight to stand and walk.Conclusion Comprehensive treatment with serial gypsum fixation,orthosis and rehabilitation training is effective for congenital dislocation of knee joint and can avoid the trauma and pain caused by surgery in older children.