Hebela N, Keenan M A E
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Eura Medicophys. 2004 Jun;40(2):145-56.
Orthopedic surgery can help restore extremity function to many patients with upper motor neuron syndromes (UMN). Impairments are divided into those that cause problems with the active function of the extremity versus those that impede passive function. Limb deformities commonly result from both dynamic (spastic) and static (contractural) components. Clinical examination supplemented with dynamic electromyographic studies provides the optimal information for planning the most effective surgical procedures. In the upper extremity, selective lengthening of the shoulder adductors and extensors combined with elbow flexor lengthening can improve forward reach. Lengthening of the forearm pronators and finger flexors will improve hand use. In the lower extremity, standing balance is improved with widening the base of support by correcting hip adduction contractures and equinovarus foot deformities. Improvement of knee flexion during swing phase by a rectus femoris to gracilis transfer will enhance the fluidity and efficiency of walking. Correction of hip and knee flexion contractures will allow a upright posture and dramatically decrease the energy requirement of walking.
骨科手术可以帮助许多上运动神经元综合征（UMN）患者恢复肢体功能。损伤可分为导致肢体主动功能出现问题的损伤和阻碍被动功能的损伤。肢体畸形通常由动态（痉挛性）和静态（挛缩性）因素共同导致。临床检查辅以动态肌电图研究可为规划最有效的外科手术提供最佳信息。在上肢，选择性延长肩内收肌和伸肌并结合延长肘屈肌可改善前伸范围。延长前臂旋前肌和手指屈肌将改善手部功能。在下肢，通过纠正髋内收挛缩和马蹄内翻足畸形来扩大支撑面可改善站立平衡。股直肌转位至股薄肌以改善摆动期膝关节屈曲，将提高步行的流畅性和效率。纠正髋部和膝部屈曲挛缩将使患者能够保持直立姿势，并显著降低步行的能量需求。
