Poul J, Raiser V
Klinika dĕtské chirurgie, ortopedie a traumatologie, Dĕtská nemocnice FN, Brno.
Acta Chir Orthop Traumatol Cech. 2003;70(4):237-42.
To evaluate the contribution of different surgical techniques of lengthening of distal hamstrings on the development of hyperextension deformity of the knee in spastics.
Totally 51 patients of age 7.6 + 3.7 years at operation. Follow-up after surgical release for 4-10 years. Basically two surgical techniques were used: 1. Simple division of gracilis and semitendinosus, fractional lengthening of semimembranosus and biceps femoris. 2. Gracilis and semitendinosus were anchored after its transverse division to fractionally lengthened semimembranosus.
Pre-operative and post-operative Bleck popliteal angles were estimated. Hyperextension was tested in lying and standing positions.
Type of surgery (1 or 2) did not influence the development of hyperextension deformity of the knee (tested by Fisher exact test). Nevertheless the relation between type of surgery (1 or 2) and the stratified value of Bleck popliteal angle was statistically significant. In the subgroup 2, in which the superficial tendons were anchored to semimebraneous, the occurrence of values of Bleck angle less than 20 degrees, was lower than in the subgroup 1.
It seems, that the type of described two different surgical techniques is not so much decisive for development of hyperextension deformity.
Authors surmise, that principal role play stronger deep knee flexors (semimembranosus and biceps femoris). Its fractional lengthening must be very careful.
评估不同的腘绳肌远端延长手术技术对痉挛患者膝关节过伸畸形发展的影响。
共有51例患者接受手术，手术时年龄为7.6±3.7岁。术后随访4至10年。基本上采用了两种手术技术：1. 单纯切断股薄肌和半腱肌，对半膜肌和股二头肌进行分次延长。2. 将股薄肌和半腱肌横行切断后固定于分次延长的半膜肌上。
评估术前和术后的Bleck腘角。在仰卧位和站立位测试膝关节过伸情况。
手术类型（1或2）对膝关节过伸畸形的发展没有影响（通过Fisher精确检验）。然而，手术类型（1或2）与Bleck腘角分层值之间的关系具有统计学意义。在第2组亚组中，即浅肌腱固定于半膜肌的亚组，Bleck角小于20度的发生率低于第1组亚组。
似乎所描述的两种不同手术技术的类型对过伸畸形的发展并非起决定性作用。
作者推测，主要起作用者为更强有力的屈膝肌（半膜肌和股二头肌）。对其进行分次延长时必须非常谨慎。
