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 topoliomyelitis

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。

Abstract:

[Objective] To investigate the clinical results of two kinds of internal fixation of femoral supracondylar osteotomy for kneeflexion deformity secondary to poliomyelitis. [Methods] A retrospective analysis was performed on 60 patients who received femoral supra-condylar osteotomy for knee flexion deformity due to sequelae of poliomyelitis in our hospital from January 2018 to June 2021. According todoctor-patient communication, 30 cases had osteotomy site fixed by dynamic condyle screw (DCS group), 30 cases were fixed by lockingplate (LP group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in bothgroups 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 yu-an, P＜0.001]. The mean follow-up time lasted for (30.2±7.7) months, and the DCS group resumed full weight-bearing activity significantlyearlier 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 kneeextension-flexion range of motion (ROM) and HSS scores significantly increased in both groups over time (P＜0.05), whereas which were notstatistically significant between the two groups at any time points accordingly (P＞0.05). As for imaging, the knee flexion angle decreased sig-nificantly after surgery (P＜0.05), while the FTA angle and K-L grade remained unchanged in both group (P＞0.05). At the matching timepoint, 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 combined with DCS or LP fixation for the treatment of knee flexion deformity due topolio sequela is effective and safe. By comparison, the DCS fixation has advantages of short hospital stay, low cost, early ambulation and rela-tively fewer complications over the LP.