儿麻膝屈曲畸形股骨髁上截骨两种内固定比较  

Comparison of two kinds of internal fixation of femoral supracondylar osteotomy for knee flexion deformity secondary to poliomyelitis

作　　者：崔锁明 陈燕 黄超 栾峰 祁伟 CUI Suo-ming;CHEN Yan;HUANG Chao;LUAN Feng;QI Wei(Department of Orthopedics,Zhenjiang 359 Hospital,Zhenjiang 212001,China)

机构地区：[1]镇江三五九医院关节矫形科,江苏镇江212001

出　　处：《中国矫形外科杂志》2024年第21期1946-1952,共7页Orthopedic Journal of China

摘　　要：[目的]探讨儿麻膝屈曲畸形股骨髁上截骨两种内固定的临床结果。[方法]回顾性分析2018年1月—2021年6月本院行股骨髁上截骨矫形内固定治疗儿麻后遗症膝关节屈曲畸形60例患者的临床资料,根据医患沟通结果,30例采用动力髁钉板(dynamic condyle screw,DCS)固定(DCS组),30例采用锁定板(locking plate,LP)固定(LP组)。比较两组围手术期、随访和影像结果。[结果]所有患者均顺利完成手术。DCS组在手术时间[(54.1±4.3)min vs(62.5±3.2)min,P<0.001]、切口总长度[(13.4±1.0)cm vs(14.6±0.9)cm,P<0.001]、术中失血量[(39.1±4.0)ml vs(49.8±4.0)ml,P<0.001]、术中透视次数[(2.8±0.8)次vs(3.5±0.8)次,P<0.001]、下地行走时间[(92.9±3.0)d vs(102.3±5.1)d,P<0.001]、住院时间[(14.7±1.5)d vs(15.8±1.3)d,P=0.002]、住院费用[(1.6±0.1)万元vs(2.4±0.2)万元,P<0.001]均显著优于LP组。患者平均随访时间(30.2±7.7)个月。DCS组恢复完全负重活动时间[(137.4±5.8)d vs(144.4±3.2)d,P<0.001]显著早于LP组。随术后时间推移,两组的VAS评分显著降低(P<0.05),膝关节伸屈活动度、HSS临床评分显著增加(P<0.05);相应时间点,两组间上述指标的差异无统计学意义(P>0.05)。影像方面,术后两组的膝屈曲角显著减小(P<0.05),而两组的FTA角、K-L分级无明显变化(P>0.05)。相同时间点,两组的膝屈曲角、FTA角、KL分级、截骨愈合情况的差异无统计学意义(P>0.05)。[结论]股骨髁上截骨矫形结合DCS或LP固定治疗儿麻后遗症膝关节屈曲畸形疗效确切,安全性好,但DCS固定住院时间短、费用低、下地时间早、并发症相对更少。[Objective]To investigate the clinical results of two kinds of internal fixation of femoral supracondylar osteotomy for knee flexion deformity secondary to poliomyelitis.[Methods]A retrospective analysis was performed on 60 patients who received femoral supracondylar osteotomy for knee flexion deformity due to sequelae of poliomyelitis in our hospital from January 2018 to June 2021.According to doctor-patient communication,30 cases had osteotomy site fixed by dynamic condyle screw(DCS group),30 cases were fixed by locking plate(LP group).The perioperative,follow-up and imaging data were compared between the two groups.[Results]All patients in both groups had operation performed successfully.The DCS group proved significantly superior to the LP group in terms of operative time[(54.1±4.3)mim vs(62.5±3.2)min,P<0.001],total incision length[(13.4±1.0)cm vs(14.6±0.9)cm,P<0.001],intraoperative blood loss[(39.1±4.0)ml vs(49.8±4.0)ml,P<0.001],intraoperative fluoroscopy times[(2.8±0.8)vs(3.5±0.8)times,P<0.001],walk time[(92.9±3.0)days vs(102.3±5.1)days,P<0.001],hospital stay[(14.7±1.5)days vs(15.8±1.3)days,P=0.002],hospitalization cost[(1.6±0.1)10k yuan vs(2.4±0.2)10k yuan,P<0.001].The mean follow-up time lasted for(30.2±7.7)months,and the DCS group resumed full weight-bearing activity significantly earlier than the LP group[(137.4±5.8)days vs(144.4±3.2)days,P<0.001].The VAS scores significantly decreased(P<0.05),while the knee extension-flexion range of motion(ROM)and HSS scores significantly increased in both groups over time(P<0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P>0.05).As for imaging,the knee flexion angle decreased significantly after surgery(P<0.05),while the FTA angle and K-L grade remained unchanged in both group(P>0.05).At the matching time point,there were no significant differences in knee flexion angle,FTA angle,K-L grade and osteotomy healing between the two groups(P>0.05).[Conclusion]Femoral supracondylar osteotomy combi

关 键 词：儿麻后遗症 膝关节屈曲畸形 股骨髁上截骨 动力髁钉板 锁定钢板 

分 类 号：R682.6[医药卫生—骨科学]