Abstract
Background. Knee flexion contractures frequently present in children with arthrogryposis and significantly alter kinematics of walking and reduce efficiency of ambulation or render it impossible. There are variety of surgical options for contracture correction, including entire soft-tissue release or its combination with Ilizarov ex-fix and supracondylar femoral osteotomy. Choosing of the most effective surgery is challenging because every method has limitations.Aim. To evaluate the treatment outcomes of knee flexion deformity correction by guided growth in patients with arthrogryposis.Materials and methods. A total of 12 patients (20 knee joints) with arthrogryposis who underwent anterior distal femoral hemiepiphysiodesis with 8 plates for knee flexion contracture correction were included in the study. The average age at surgery was 6.5 ± 0.5 (range, 4.3–9.6) years. Clinical and radiological methods were used with statistical analysis of the data.Results. The mean preoperative knee flexion deformity angle was 48.5° ± 4.04° (range, 20°–80°). After distal femoral hemiepiphysiodesis, a reduction of knee flexion contracture was observed in 17 (85%) patients during a follow-up period of 18–36 months. The average correction was 20° ± 2.67° (range, 0°–40°) (p < 0.05). The residual deformity angle was 28.5° ± 6.03° (range, 0°–60°). Patients with contractures up to 50° demonstrated the most significant correction (by 90% compared with the initial value) (p < 0.05). This group included patients with severe flexion contractures, treated by serial casting, combined with an extension devise before surgery, which contributed to a significant reduction of the contracture.Conclusion. Distal femoral hemiepiphysiodesis is an effective, safe, and reproducible surgical option for knee flexion contractures in patients with arthrogryposis. Combination with additional methods enables significantly reduction of knee flexion deformities from severe to moderate, thereby rendering treatment more effective with a shorter duration, which allows prompt improvement in ambulatory capacity.
Highlights
Knee flexion contractures frequently present in children with arthrogryposis and significantly alter kinematics of walking and reduce efficiency of ambulation or render it impossible
A reduction of knee flexion contracture was observed in 17 (85%) patients during a follow-up period of 18–36 months
Distal femoral hemiepiphysiodesis is an effective, safe, and reproducible surgical option for knee flexion contractures in patients with arthrogryposis
Summary
Использование метода управляемого роста для устранения сгибательной контрактуры коленного сустава у пациентов с артрогрипозом: предварительные результаты. Целью исследования было оценить результаты коррекции сгибательных контрактур коленных суставов с помощью метода управляемого роста у пациентов с артрогрипозом. В исследование было включено 12 пациентов с артрогрипозом со сгибательными контрактурами коленных суставов (20 коленных суставов), которым выполнялся временный гемиэпифизеодез передней части дистальной зоны роста бедренной кости с использованием 8-образных пластин. За период наблюдения от 18 до 36 месяцев после гемиэпифизеодеза дистальной зоны роста бедренной кости было отмечено уменьшение сгибательной контрактуры коленного сустава в 17 случаях (85 %) в среднем на 20 ± 2,67° (0–40°), p < 0,05. В этой группе были пациенты с тяжелыми сгибательными контрактурами, которым до операции производилась попытка их коррекции гипсовыми повязками с дистракционным устройством, в результате чего величина контрактуры была значительно уменьшена. For citation: Pediatric Traumatology, Orthopaedics and Reconstructive Surgery, 2016;4(4):
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