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頁籤選單縮合
題名 | Early Reduction for Congenital Dislocation of the Knee within Twenty-four Hours of Birth=出生二十四小時之內以早期整復治療先天性膝關節脫臼 |
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作者 | 程俊傑; 郭繼陽; | 書刊名 | 長庚醫誌 |
卷期 | 33:3 2010.05-06[民99.05-06] |
頁次 | 頁266-273 |
分類號 | 416.61 |
關鍵詞 | 先天性膝關節脫臼; 髖臼發育不良; Congenital dislocation of the knee; CDK; Developmental hip dysplasia; DDH; |
語文 | 英文(English) |
中文摘要 | 1990 7 2007 6 () 4.3 () |
英文摘要 | Background: Congenital dislocation of the knee (CDK) is a very rare condition that comprises a spectrum of deformities from subluxation to complete dislocation. The incidence of CDK is estimated at 1 per 100,000 live births, which is 1% of the incidence of developmental dysplasia of the hip (DDH). Moreover, 40–100% of patients with CDK have additional musculoskeletal anomalies, the most common being DDH and clubfoot. In general, the diagnosis is established immediately after birth according to the position of the knee recurvatum. Treatment with conservative methods at an early stage is most likely to yield successful results. We report here successful treatment of a series of CDK patients with early reduction. Methods: From July 1990 to June 2007, 19 patients with CDK (affecting 25 knees) were treated with early reduction. Of these, 6 knees had dislocation, and 19 had subluxation. Since 1990, treatment has been guided by a protocol that considers patient age and the severity of the condition. In patients examined within 24 hours of birth, early, direct reduction under gentle, persistent manual traction was attempted. Birth history and perinatal course were obtained from medical records. Associated musculoskeletal anomalies were observed and treated after reduction of the knee joint. A Pavlik harness was used for at least 4 months in the concomitant treatment of DDH and CDK. Knee function was graded as excellent, good, fair, or poor. Radiographs were used to assess DDH during follow-up. Results: After an average follow-up duration of 4.3 years, 18 patients showed an excellent or good outcome. One patient, whose knee could not be reduced, had severe multiple anomalies and died 16 days after birth. Fifteen of the nineteen patients had associated musculoskeletal anomalies, including DDH and foot deformity. Two cases of residual hip dysplasia after Pavlik harness application required an acetabular osteotomy. Conclusions: For CDK patients, early and direct closed reduction within 24 hours of birth affords outcomes graded as either excellent or good. |
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