Scott Allison C, Scarborough Nancy
Shriners Hospital for Children, Houston, TX 77030, USA.
J Pediatr Orthop. 2006 Nov-Dec;26(6):777-80. doi: 10.1097/01.bpo.0000242427.99113.d7.
The purpose of this study was to assess the outcome of split posterior tibial tendon transfers in patients with spastic cerebral palsy to determine whether the use of preoperative dynamic electromyography was predictive of surgical success. The study is a consecutive case series of 25 children with spastic hemiplegia who underwent unilateral split posterior tibial tendon transfers for varus foot deformities. Three patients were considered failures because of residual varus, which required further surgery. An additional 5 patients had mild residual varus. Preoperative dynamic electromyographic data were evaluated to determine the etiology of postoperative undercorrection. Undercorrection seems to be related to unrecognized anterior tibial muscle overactivity and advanced age at surgery. Overcorrection did not occur. Dropfoot was noted postoperatively in 52% of patients and was related to early cessation of anterior tibial muscle activity in swing. Split posterior tibial tendon transfer is a successful surgery on those patients with increased posterior tibial muscle activity. Undercorrection can be avoided by assessing the activity of the anterior tibial muscle before surgery. These results are expected to assist in surgical decision making for the equinovarus foot in cerebral palsy.
本研究的目的是评估痉挛性脑瘫患者胫后肌腱劈开转移术的疗效，以确定术前动态肌电图检查能否预测手术成功。该研究是对25例痉挛性偏瘫儿童进行的连续病例系列研究，这些儿童因内翻足畸形接受了单侧胫后肌腱劈开转移术。3例患者因残留内翻被视为手术失败，需要进一步手术。另外5例患者有轻度残留内翻。对术前动态肌电图数据进行评估，以确定术后矫正不足的病因。矫正不足似乎与未被识别的胫骨前肌过度活动和手术时年龄较大有关。未发生矫正过度。52%的患者术后出现足下垂，这与摆动期胫骨前肌活动过早停止有关。对于胫后肌活动增加的患者，胫后肌腱劈开转移术是一种成功的手术。术前评估胫骨前肌的活动可以避免矫正不足。这些结果有望有助于脑瘫马蹄内翻足的手术决策。
