先天性胫骨前脱位患者在治疗过程中的临床和影像学表现比较

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详细

论证。先天性胫骨前脱位是一种非常罕见的肌肉骨骼系统疾病。据报道，每10万活产婴儿中约有1例。许多研究人员指出，先天性胫骨前脱位的治疗应从保守疗法开始，而保守疗法有时会产生各种并发症。

目的。本研究旨在比较先天性胫骨前脱位的临床和放射学分类，证明使用Von Rosen夹板和石膏矫正治疗的效果，以及使用临床和放射学数据评估畸形初始严重程度的预后意义。

材料和方法。研究包括58名先天性胫骨前脱位患者（83个膝关节）。其中男孩34人，女孩24人。先天性胫骨前脱位伴关节弯曲等全身病变的病例未纳入研究。在治疗前，根据Tarek和J Leveuf 系统对所有患者的先天性胫骨前脱位严重程度进行了测定。使用了非参数统计方法来分析所获得的结果。组间差异采用Kraskell-Wallis标准和中位数检验进行评估。使用Spearman系数搜索相关性。统计分析使Statistica v10软件进行。

结果。对临床和放射学数据进行了比较。两组患者在保守治疗后，近98%的患者获得了极佳和良好的效果，2%的患者获得了满意的效果。在37例保守治疗后出现Tarek III膝关节畸形的病例中，有2例需要进行手术治疗。

结论。根据Tarek系统得出的畸形严重程度可以预测先天性胫骨前脱位保守治疗的效果，并具有显著的统计学意义。

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作者简介

Igor Yu. Kruglov

Almazov National Medical Research Centre

Email: dr.gkruglov@gmail.com
ORCID iD: 0000-0003-1234-1390
SPIN 代码: 7777-1047
Scopus 作者 ID: 57193279395

MD, Paediatric Orthopaedic Surgeon

俄罗斯联邦, Saint Petersburg

Nicolai Yu. Rumyantsev

Almazov National Medical Research Centre

Email: dr.rumyantsev@gmail.com
ORCID iD: 0000-0002-4956-6211

MD, Paediatric Orthopaedic Surgeon

俄罗斯联邦, Saint Petersburg

Alexey G. Baindurashvili

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: turner011@mail.ru
ORCID iD: 0000-0001-8123-6944
SPIN 代码: 2153-9050
Scopus 作者 ID: 6603212551

MD, PhD, Dr. Sci. (Med.), Professor, Member of RAS, Honored Doctor of the Russian Federation

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Gamzat G. Omarov

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: ortobaby@yandex.ru
ORCID iD: 0000-0002-9252-8130

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Natalia N. Rumiantceva

Almazov National Medical Research Centre

Email: natachazlaya@mail.ru
ORCID iD: 0000-0002-2052-451X
SPIN 代码: 3497-3878

MD, Paediatric Orthopaedic Surgeon

俄罗斯联邦, Saint Petersburg

Olga Yu. Razmologova

Almazov National Medical Research Centre

Email: or1973@yandex.ru
ORCID iD: 0000-0001-7073-899X
SPIN 代码: 7608-8718

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Olga M. Vorobeva

Almazov National Medical Research Centre

Email: olgarasp@yandex.ru
ORCID iD: 0000-0002-1349-7349
SPIN 代码: 3327-7617
Scopus 作者 ID: 57205331117
Researcher ID: AAZ-5818-2020

MD, Pathologist

俄罗斯联邦, Saint Petersburg

Tatiana M. Pervunina

Almazov National Medical Research Centre

Email: ptm.pervunina@yandex.ru
ORCID iD: 0000-0001-9948-7303
SPIN 代码: 3288-4986
Scopus 作者 ID: 56572907100

MD, PhD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Ilya M. Kagantsov

Almazov National Medical Research Centre; North-Western State Medical University named after I.I. Mechnikov

编辑信件的主要联系方式.
Email: ilkagan@rambler.ru
ORCID iD: 0000-0002-3957-1615
SPIN 代码: 7936-8722
Scopus 作者 ID: 55358760000

MD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

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2. Fig. 1. Congenital knee dislocation severity according to the Leveuf classification [1]: a, grade I (recurvation); b, grade II (subluxation); c, grade III (dislocation)

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3. Fig. 2. Radiogram of the knee joint of patient R., age 2 weeks. Knee joint subluxation (grade II according to the Leveuf system). Hyperextension in the knee joint 43°

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4. Fig. 3. Distribution of knee joints according to the severity of congenital knee dislocation as assessed by the Tarek system (n = 83)

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5. Fig. 4. Distribution of the knee joints depending on the severity of deformity according to the Leveuf system [7] and treatment method (n = 83)

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6. Fig. 5. Scale for evaluating treatment results proposed by the authors: I, correct position of the bones and flexion at the knee joint >120°; II, correct position of the bones and flexion at the knee joint of 90–120°; III, correct position of the bones and flexion at the knee joint of 50–90°; IVA, correct position of the bones and flexion at the knee joint from 0 to 50°; IVB, flexion at the knee joint up to 90° with persistent anterior subluxation of the tibia

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7. Fig. 6. Results of conservative treatment of congenital knee dislocation, depending on the treatment method: 1, plaster correction; 2, von Rosen splint

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8. Fig. 7. Knee joint flexion as a result of treatment, depending on the initial assessment according to the Tarek (a) and J. Leveuf (b) systems: 1, plaster correction; 2, von Rosen splint

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9. Fig. 8. Differences in the passive flexion of the knee joint depending on the initial Tarek score

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10. Fig. 9. Differences in passive flexion of the knee joint after treatment in patients, depending on the initial assessment according to the Leveuf system [7]

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11. Fig. 10. Possible complications in the treatment of congenital knee dislocation: a, photo of patient N., 1 month old, skin maceration under a plaster cast in the area of compression; b, radiograph of the knee joint of patient A., 4 months old, epiphysiolysis of the proximal end of the tibia; c, appearance of the same patient

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版权所有 © Kruglov I., Rumyantsev N., Baindurashvili A., Omarov G., Rumiantceva N., Razmologova O., Vorobeva O., Pervunina T., Kagantsov I., 2023


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