Neuro-orthopedic approach to treatment of contractures in patients with spastic paresis



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The objective of the study was the analysis of possibility of correction of contractures in children with spastic cerebral palsy after combined (neurosurgical and orthopedic) treatment. The total amount of patients was 29 (41 segments). Neurosurgical options included selective neurotomies of the branches of tibial nerve in spastic deformities of the feet in all of the patients were treated (41 procedures respectively). Orthopedic options included tenomyoplastic procedures (Achilles tendon lengthening, gastrocnemius aponeurotic lengthening) in 26 of the patients presenting with accompanying fixed contractures. Preoperative and postoperative investigation included clinical assessment (range of passive and active motion, Ashworth scale assessment) and electroneuromyography. The surgical procedure was performed by intraoperative electrostimulating control. The average postoperative follow-up was 11 months, 20 patients (28 segments) were surveyed. Decrease of the muscle tone was recognized in all of the cases, the average rate of diminishing was 57.5 %. The clonic reaction of foot was diminished or disappeared in 73 % of the cases. Achilles reflex was normalized in all of the patients. Electromyographic data did not reveal any trends. Particular deformation relapse was observed in 19 segments. The analysis of the presented material allows making a conclusion that combined single-event neurosurgical and orthopedic treatment is the method of choice in presence of the high tone and progressive or existing muscular contracture in evidence of inefficiency of conservative treatment in children with cerebral palsy.

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V V Umnov

V M Kenis

Email: kenis@mail.ru

References

  1. Banks, H.H. Adductor myotomy and obturator neurotomy for the correction of adductive contracture of the hip in cerebral palsy / H.H. Banks, W.T. Green // J. Bone Joint Surg. - 1960. - Vol. 42-A . - P. 111-126.
  2. Banks, R.W. Specificities of afferents reinnervating cat muscle shindles after nerve section / R.W. Banks, D. Barker // J. Physiol. - 1989. - Vol. 408. - P. 345-372.
  3. Berard, C. Selective neurotomy of the tibial nerve in the spastic hemiplegic child: an explanation of the recurrence / C. Berard, M. Sindou, J. Berard, H. Carrier // J. Pediatr. Orthop. (B). - 1998. - Vol. 7. - P. 66-70.
  4. Brown, M.C. Regeneration of afferent and efferent fibers to muscles spindles after nerve injury in adults cats / M.C. Brown, R.G. Butler // J. Physiol. - 1976. - Vol. 260. - P. 253-266.
  5. Brunelli, G. Hyponeurotisation selective microchirurgicale dans les paralysies spastiques / G. Brunelli, F. Brunelli // Ann. Chir. Main. - 1983. - Vol. 2. - P. 277-280.
  6. Caillet, F. The development of gait in the hemiplegic patient after selective tibial neurotomy / F. Caillet, P. Mertens, S. Rabaseda, D. Boisson // Neurochirurgie. - 1998. - Vol. 44. - P. 183-191.
  7. Collins, W.F. On the specificity of sensory reinnervation of the cat skeletal muscle / W.F. Collins, L.M. Mendell, J.B. Munson // J. Physiol. - 1986. - Vol. 375. - P. 587-609.
  8. Decq, Ph. Neurotomiea peripheriques selectives des collaterales pour les muscles ischio-jambiers dans le traitment de la spasticite en flexion du genou. A propos d'une serie de 11 patients / P. Decq, P. Filipetti, A. Feve, A. Saraoui // Neurochirurgie. - 1996. - Vol. 42. - P. 275-280.
  9. Decq, Ph. Soleus neurotomy for treatment of the spastic equinus foot / Ph. Decq [et al.] // Neurosurgery. - 2000. - Vol. 47. - P. 1154-1161.
  10. Decq, Ph. Peripheral neurotomies for the treatment of local spasticity of the limbs / Ph. Decq // Neurochirurgie. - 2003. - Vol. 49. - P. 293-305.
  11. Deltombe, T. Selective fascicular nerotomy for spastic equinovarus foot deformity in cerebral palsy children / T. Deltombe [et al.] // Acta Orthop. Belg. - 2001. - Vol. 67. - P. 1-5.
  12. Einsiedel, L.J. Activity and motor unit size in partially denervated rat medial gastrocnemius / L.J. Einsiedel, A.R. Luff // J. Appl. Physiol. - 1994. - Vol. 76. - P. 2663-2671.
  13. Feve, A. Physiological effects of selective tibial neurotomy on lower limb spasticity / A. Feve [et al.] // J. Neurol. Neurosurg. Psychiatr. - 1997. - Vol. 63. - P. 575-578.
  14. Filipetty, P. Interest of anesthetic blocks for assessment of the spastic patient. A series of 815 motor blocks / P. Filipеtty, Ph. Decq // Neurochirurgie. - 2003. - Vol. 49. - P. 226-238.
  15. Gros, C. La chirurgie de la spasticite / C. Gros // Neurochirurgie. - 1972. - Vol. 23. - P. 316-388.
  16. Lorenz, F. Uber chirurgische Behandlung der Angeborenen spastischen Gliedstarre / F. Lorenz // Wien Klin. Rdsch. - 1887. - Vol. 21. - P. 25-27.
  17. Msaddi, A.K. Microsurgical selective peripheral neurotomy in the treatment of spastisity in cerebral-palsy children / A.K. Msaddi [et al.] // Stereotact. Funct. Neurosurg. - 1997. - Vol. 69. - P. 251-258.
  18. Park, D.M. Direct muscle neurotization in rat soleus muscle / D.M. Park, S.K. Shon, Y.J. Kim // J. Reconstr. Microsurg. - 2000. - Vol. 16. - P. 379-383.
  19. Sindou, M. Microsurgical ablative procedures in the peripheral nerves and dorsal root entry zone for relief of focal spasticity in the limbs / M. Sindou, P. Mertens, D. Jeanmonod // Stereotact. Funct. Neurosurg. - 1990. - Vol. 54-55. - P. 140-146.
  20. Stoffel, A. The treatment of spastic contractures / A. Stoffel // Am. J. Orthop. Surg. - 1912. - Vol. 10. - P. 611-644.
  21. Wang, S.J. Neurotomy of the tibial nerve for treatment of the talipes equinovarus / S.J. Wang, G.Q. Chen, B. Xiu, H.C. Zuo // Zhonghua Wai Ke Za Zhi. - 2005. - Vol. 43, N 9. - P. 605-607.

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Copyright (c) 2009 Umnov V.V., Kenis V.M.

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