手法与树脂夹板治疗婴儿先天性膝关节脱位

发布时间：2019-04-19 04:30

【摘要】：[目的]探讨采用手法矫正后高分子树脂石膏固定治疗婴儿先天性膝关节脱位的方法及疗效。[方法]2009年12月~2016年11月共收治先天性膝关节脱位患儿26例(32膝),其中女22例,男4例,首诊年龄1 h~1个月27 d,单纯脱位9例9膝,复合畸形14例18膝,综合征3例5膝。每日白天手法矫正逐渐增加膝关节屈曲角度,夜间采用可重复利用高分子夹板固定,达到复位后以石膏或支具维持至膝关节稳定,治疗后定期随访。[结果]所有病例均获得6个月~7年的随访。单纯性脱位与复合畸形患儿27膝关节过伸消失,膝关节屈曲功能完全恢复(100%);合并多发性关节挛缩症患儿中3膝主动屈曲角度达140°以上,关节屈曲功能恢复,1膝主动屈曲角度达120°左右,关节屈曲功能基本恢复,能达到正常生活需要,1例合并Crouzon综合征患儿,1膝屈曲有改善但未达到正常生活需要,需要手术治疗;三组间治疗前关节活动度比较差异无统计学意义(P0.05),但治疗后综合征患者与单纯脱位患者、复合畸形患者的屈膝位ROM差异有统计学意义(P0.05)。本组全脱位10膝,半脱位22膝。末次随访时整体优良率为96.88%,而且无论全脱位还是半脱位,膝关节治疗效果差异无统计学意义(P0.05),其中:半脱位22膝、全脱位8膝关节功能评估"优"(93.75%);1膝综合征患儿为"良"(3.12%),1膝合并Crouzon综合征患儿为"差"(3.12%)。[结论]患有先天性膝关节全脱位及半脱位的婴儿,无论是否合并畸形,可以采用每日白天手法矫正,夜间高分子树脂石膏固定进行治疗,避免手术治疗的创伤。
[Abstract]:[objective] to investigate the treatment of congenital dislocation of knee joint with high molecular resin plaster fixation after manual correction. [methods] from December 2009 to November 2016, 26 cases (32 knees) of congenital dislocation of knee joint were treated. Among them, 22 cases were female and 4 cases were male. The age of first diagnosis was 1 h / month 27 days, 9 cases (9 knees) with simple dislocation, 14 cases (18 knees) with complex deformity, and 9 cases (9 knees) with simple dislocation. 3 cases (5 knees) with syndrome. Day-to-day manual correction gradually increased the flexion angle of knee joint. At night, the knee joint was fixed with reusable polymer splint. The knee joint was stabilized by plaster or brace after reduction, and was followed up regularly after treatment. [results] all cases were followed up for 6 months to 7 years. In the children with simple dislocation and complex deformity, the overextension of the knee joint disappeared and the flexion function of the knee joint recovered completely (100%). In the children with multiple joint contracture, the active flexion angle of 3 knees was more than 140 掳, the joint flexion function was restored, and the active flexion angle of one knee was about 120 掳. The joint flexion function was basically restored, which could meet the needs of normal life. One child with Crouzon syndrome had improved knee flexion but did not meet the needs of normal life and needed surgical treatment. There was no significant difference in joint mobility between the three groups before treatment (P0.05), but there was a significant difference in knee flexion ROM between patients with syndrome and simple dislocation and complex deformity after treatment (P0.05). Total dislocation in 10 knees and subluxation in 22 knees. At the last follow-up, the overall excellent and good rate was 96.88%, and there was no significant difference in the treatment effect of knee joint between total dislocation and subluxation (P0.05), among which 22 knees were subluxated. Total dislocation 8 knee joint function evaluation "excellent" (93.75%); One knee syndrome was "good" (3.12%), and one knee complicated with Crouzon syndrome was "poor" (3.12%). [conclusion] infants with congenital total dislocation or subluxation of knee joint can be treated with day-to-day manual correction and night-time high molecular resin plaster fixation, no matter whether they are complicated with deformity or not, so as to avoid the trauma of surgical treatment.
【作者单位】：河北省儿童医院;
【分类号】：R726.8

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