脑瘫患儿膝关节屈曲挛缩的外科治疗。文献综述

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膝关节屈曲挛缩在脑瘫患儿所有下肢畸形中占据主要地位，发生率为47%–53%。该病长期存在会导致显著的功能障碍：步行能量消耗增加、儿童运动能力下降及继发性骨科并发症，严重影响患者生活质量。本文分析了已发表的文献资料，内容涉及脑瘫患儿膝关节屈曲挛缩的现代外科矫治方法，评估了这些方法的临床疗效，指出了并发症的发生频率，并明确了影响最佳治疗策略选择的相关因素。检索PubMed、Google Scholar、Cochrane Library、Crossref和eLibrary数据库。检索时间范围为1952年至2024年，不设语言限制。最终纳入74篇文献，包括原始研究和系统综述，均涉及脑瘫患儿膝关节屈曲挛缩的外科治疗。胫骨屈肌延长术和股骨矫形性伸直型髁上截骨术被认为是脑瘫患儿膝关节屈曲挛缩的主要矫治方法。屈肌延长术被认为是主要的手术方式，最适用于各年龄段的患者。同时应强调，股骨截骨术在年长的患者中，尤其是股骨远端严重畸形者中具有较高的临床疗效。两种方法均显示出良好结果，但可能伴随一定并发症风险。文献中还分析了替代方法，包括肌腱转位、临时性半骺阻滞术及联合治疗策略。文献综述表明，脑瘫患儿膝关节屈曲挛缩的外科治疗是一种有效的方法，但具体手术方式的选择应基于患者的个体解剖和临床特点、挛缩程度及年龄特征。

作者简介

Alina Mustafaeva

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: alina.mys23@yandex.ru
ORCID iD: 0009-0003-4108-7317
SPIN 代码: 1099-7340

MD

俄罗斯联邦, Saint Petersburg

Vladimir Novikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: novikov.turner@gmail.com
ORCID iD: 0000-0002-3754-4090
SPIN 代码: 2773-1027

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Valery Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: umnovvv@gmail.com
ORCID iD: 0000-0002-5721-8575
SPIN 代码: 6824-5853

MD, PhD, Dr. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Sergei Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN 代码: 7125-4930

MD, PhD, Dr. Sci. (Medicine), Professor, Corresponding Member of RAS

俄罗斯联邦, Saint Petersburg

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2. Fig. 2. Stages of the surgical technique of lengthening the flexors of the lower leg: a - access to the medial and lateral groups of the flexor tendons of the lower leg; b - lengthening the medial and lateral groups of tendons: 1 - tenotomy of the gracilis muscle, 2 - tenotomy of the semimembranosus muscle, 3 - tenotomy of the semitendinosus muscle, 4 - tenotomy of the biceps femoris; c - diagram of Z-shaped lengthening of the medial group: 5 - Z-shaped lengthening of the semitendinosus muscle.

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3. Fig. 3. X-rays of the knee joint with temporary hemiepiphysiodesis of the anterior femur: a - lateral projection of the knee joint; b - direct projection of the knee joint.

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4. Fig. 4. Lateral radiographs of the patient's knee joint: a — preoperative radiograph with flexion contracture of the knee joint, the value of which is 30°; b — postoperative radiograph after corrective supracondylar extension-shortening osteotomy of the femur. The arrow indicates the angular deformity of the distal femur.

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5. Fig. 1. Mechanism of knee flexion contracture development in patients with cerebral palsy.

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