Decq P, Filipetti P, Cubillos A, Slavov V, Lefaucheur J P, Nguyen J P
Service de Neurochirurgie, Hôpital Henri Mondor, Créteil, France.
Neurosurgery. 2000 Nov;47(5):1154-60; discussion 1160-1. doi: 10.1097/00006123-200011000-00027.
This prospective, nonrandomized, noncontrolled study was performed to evaluate the results of a new type of neurotomy, namely the soleus neurotomy, for treatment of the spastic equinus foot.
Between May 1996 and March 1998, 46 patients were treated for a spastic equinus foot. Clinical status, spasticity (Ashworth Scale score), and kinematic parameters of the gait were determined before and after surgery. The neurotomy was performed on the upper nerve of the soleus in all cases and was associated with other neurotomies (lower nerve of the soleus, 21 patients; gastrocnemius, 9 patients, tibialis posterior, 18 patients; flexor hallucis longus, 16 patients; and flexor digitorum longus, 17 patients).
The mean follow-up period was 15 months (range, 8-28 mo). The equinus deformity disappeared clinically in all patients. Before the operation, all patients had an Ashworth Scale score of 2, with an inexhaustible clonus present on knee extension and persisting with knee flexion (Tardieu Scale score, 4), which was abolished in 95% of the patients after surgery. Two patients still had some clonus on knee extension; this did not interfere with their clinical improvement. Knee recurvatum disappeared in eight patients. Analysis of kinematic parameters demonstrated a statistically significant increase in joint motion of the second rocker (P = 0.0026) of the ankle during stance. The duration of the stance or swing phase, length of the walking cycle, and velocity or rate of spontaneous walking were not significantly modified.
The study demonstrated that soleus neurotomy is effective for the treatment of spastic equinus foot, leading to abolition of spasticity and improvement in the range of ankle motion during the stance phase of gait.
本前瞻性、非随机、非对照研究旨在评估一种新型神经切断术，即比目鱼肌神经切断术治疗痉挛性马蹄足的效果。
1996年5月至1998年3月期间，46例痉挛性马蹄足患者接受了治疗。在手术前后分别测定临床状况、痉挛程度（Ashworth量表评分）和步态运动学参数。所有病例均对比目鱼肌上神经进行神经切断术，并联合其他神经切断术（比目鱼肌下神经，21例；腓肠肌，9例；胫后肌，18例；拇长屈肌，16例；趾长屈肌，17例）。
平均随访期为15个月（范围8 - 28个月）。所有患者的马蹄足畸形在临床上均消失。术前，所有患者的Ashworth量表评分为2分，膝关节伸展时出现持续性阵挛，膝关节屈曲时仍存在（Tardieu量表评分，4分），术后95%的患者阵挛消失。2例患者膝关节伸展时仍有一些阵挛；但这并未影响他们的临床改善。8例患者的膝反张消失。运动学参数分析显示，站立期踝关节第二摆动期的关节活动度有统计学意义的增加（P = 0.0026）。站立期或摆动期的持续时间、步行周期长度以及自发步行的速度或速率均无显著改变。
该研究表明，比目鱼肌神经切断术治疗痉挛性马蹄足有效，可消除痉挛并改善步态站立期踝关节的活动范围。
