梿枷膝的分型治疗及远期随诊观察

根据膝关节周围软组织及关节囊韧带的张力和膝关节姿势将梿枷膝分为3型,又根据生物力学原理及实验室研究设计了3种术式而开展了分型冶疗。Ⅰ型为屈曲型,膝后软组织较为紧张,膝关节不能伸直处于屈曲挛缩状态。采用股骨髁上后倾角截骨术冶疗。Ⅱ型为反屈型,即膝周围软组织松弛无力,处于过伸状态,采用膝前骨块阻挡术治疗。Ⅲ型为中立型,外观无明显畸形,治疗上采用梿枷膝改造术,即于股骨髁上4～6cm处作向后呈角截骨再于胫骨平台前缘植入骨块作阻挡术,则可恢复梿枷膝的负重功能。对Ⅰ型181例,Ⅱ型24例,Ⅲ型19例进行了随诊,随诊6年以上的125例,9～13年99例,平均8年5个月。优良率为81.7％。

CLASSIFICATION AND SURGICAL TREATMENT OF POST-POLIOMYELITIS FLAIL KNEES

According to the tone of the joint capsale and ligaments and the shape of the knee joint, flail knees can be classified in three types. Accordingly three different treatment modalities are devised.(1)Fle-tion type: Owing to a high tension of the tissues on the posterior aspect of the knee, the knee is maintained in a flexion deformity. It should be corrected by a supracondylar retroverted ostectomy. (2) Hy-perextension type: The knee is in hyperextension position on account of abnormal looseness of tissues around the knee joint. The treatment is bone-grafting in front of the knee. (3) Neutral type: There is no obvious deformity. The treatment consists of supracondylar retroverted ostectomy together with bone-grafting anterior to tibial plateau. By this means, it is possible to restore stability and weight-bearing function of the knee joint.Altogether 224 cases were treated (type 1 181, type 2 24, type 3 19), and 125 cases were folio-wed-up seen in 81.7% of cases.