先天性膝关节脱位12例早期治疗分析  

Analysis of early treatment of 12 cases with congenital knee dislocation

作　　者：刘振兴 李庭 亓会涛 王星 王延宙 Liu Zhenxing;Li Ting;Qi Huitao;Wang Xing;Wang Yanzhou(Department of Orthopedics Trauma,People′s Hospital Affiliated to Shandong First Medical University,Ji′nan 271100,China;Department of Pediatric Orthopedics,Provincial Hospital Affiliated to Shandong First Medical University,Ji′nan 250021,China)

机构地区：[1]山东第一医科大学附属人民医院创伤骨科,济南271100 [2]山东第一医科大学附属省立医院小儿骨科,济南250021

出　　处：《中华实用儿科临床杂志》2022年第20期1563-1566,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨应用Pavlik吊带及聚酯绷带石膏早期治疗先天性膝关节脱位(CDK)的疗效。方法回顾性分析2011年12月至2019年1月在山东第一医科大学附属省立医院诊治的12例(13膝)CDK患儿临床资料,其中男3例,女9例;初次就诊中位年龄3 d(1~29 d);单侧11例,双侧1例;全脱位5例(5膝),半脱位7例(8膝);7例伴其他肌肉骨骼畸形,其中6例伴发育性髋关节发育不良(DDH),1例伴双侧DDH及右侧马蹄内翻足。若膝关节可被动屈曲≥90°,则直接应用Pavlik吊带治疗1.5~2.0个月;若膝关节屈曲<90°则行连续聚酯绷带石膏矫正,每周更换1次石膏,逐渐增加屈曲角度至90°后再行Pavlik吊带治疗1.5~2.0个月。合并DDH者佩戴Pavlik吊带后彩超随访评估,合并马蹄内翻足者采用Ponseti方法聚酯绷带连续石膏治疗。结果3例(4膝)患儿直接应用Pavlik吊带固定1.5~2.0个月,9例(9膝)患儿经过1~8次(平均2.9次)石膏固定后行Pavlik吊带固定1.5~2.0个月,治疗过程中未发现石膏及Pavlik吊带并发症。12例患儿随访29.8个月(12.0~65.0个月),10例(11膝)为优,2例(2膝)为良。结论应用Pavlik吊带及聚酯绷带石膏早期治疗CDK简单、有效、安全性高,治疗中同时兼顾了伴发畸形的纠正,并强调治疗中应该首先纠正膝关节脱位。Objective To investigate the curative effect of the Pavlik harness and polyester material casting bandage for the early treatment of congenital knee dislocation(CDK).Methods The clinical data of 12 patients(13 knees)with CDK treated in Provincial Hospital Affiliated to Shandong First Medical University from December 2011 and January 2019 were studied retrospectively.There were 3 males and 9 females.The median age at the initial visit was 3 days(1-29 days).Eleven patients had unilateral CDK,and 1 patient had bilateral CDK.There were 5 cases(5 knees)with dislocation and 7 cases(8 knees)with subluxation.Associated musculoskeletal anomalies were observed in 7 patients,which included developmental dysplasia of the hip(DDH)in 6 patients,bilateral DDH and right clubfoot in 1 patient.The Pavlik harness was applied to keep the knee in position for 1.5-2.0 months if passive flexion achieved 90°or more.If passive flexion was below 90°,the polyester material casting bandage was employed to increase knee flexion,and the bandage was changed once a week.After passive flexion reached 90°,the patient was treated with the Pavlik harness for 1.5-2.0 months.Cases with DDH who worn the Pavlik harness were evaluated by ultrasonography in the follow-up period,and cases with clubfoot were treated with Ponseti polyester material casting bandages.Results Three children(4 knees)were directly fixed with Pavlik harness for 1.5-2.0 months,9 children(9 knees)were fixed with Pavlik harness for 1.5-2.0 months after 1-8 times(average 2.9 times)of plaster fixation.No plaster and Pavlik harness complications were found during the treatment.Twelve patients were followed up for 29.8 months on average(12.0 to 65.0 months).Ten patients(11 knees)were rated excellent,and 2 patients(2 knees)were rated good.Conclusions The Pavlik harness and polyester material casting bandage for early treatment of CDK is simple,effective and safe.Associated musculoskeletal anomalies can also be corrected in the treatment process.The knee joint dislocation should be tre

关 键 词：膝关节脱位 先天畸形 治疗 

分 类 号：R726.8[医药卫生—儿科]