De Pavía-Mota E, Neri-Gámez S, Reyes-Contreras G, Valencia-Posadas M
Acta Ortop Mex. 2013 Mar-Apr;27(2):109-13.
Knee flexor muscle contracture is frequent in patients with spastic cerebral palsy. The purpose of the study was to determine whether percutaneous tenotomy and aponeurotomy may decrease knee flexor contracture in children with spastic cerebral palsy.
A prospective study of consecutive cases was conducted from January to December 2009 in 24 children with a diagnosis of moderate to severe spastic cerebral palsy who had knee flexor contracture with a popliteal angle > or = 45 degrees and a gross motor function classification scale of 4 or 5; they underwent percutaneous tenotomy and aponeurotomy surgery and were followed-up for 24 months. Variance analysis with a factorial design was used for data analysis.
The mean popliteal angle was 83.48 degrees preoperatively and 27.30 degrees by the end of the follow-up, with an improvement of 56.18 degrees (p < 0.01). Statistically significant differences were found in all measurements comparing them with the baseline values.
Percutaneous aponeurotomy of knee flexor muscles is described. Compared to other procedures it provides the benefits of minimally invasive surgery, mild postoperative pain, short hospital stay -without using immobilization during the entire process- and children returned to their therapy program within five days.
Percutaneous tenotomy and aponeurotomy of knee flexors was shown to be a good alternative for the treatment of knee flexor contracture in patients with spastic cerebral palsy.
痉挛型脑瘫患者中膝屈肌挛缩很常见。本研究的目的是确定经皮肌腱切断术和腱膜切开术是否可减少痉挛型脑瘫患儿的膝屈肌挛缩。
2009年1月至12月对24例诊断为中度至重度痉挛型脑瘫且膝屈肌挛缩、腘角≥45度、粗大运动功能分级量表为4级或5级的患儿进行了连续病例的前瞻性研究；他们接受了经皮肌腱切断术和腱膜切开术，并随访24个月。采用析因设计的方差分析进行数据分析。
术前平均腘角为83.48度，随访结束时为27.30度，改善了56.18度（p<0.01）。与基线值相比，所有测量值均有统计学显著差异。
描述了膝屈肌的经皮腱膜切开术。与其他手术相比，它具有微创手术、术后疼痛轻、住院时间短（整个过程无需固定）的优点，患儿在五天内即可恢复治疗计划。
经皮膝屈肌腱切断术和腱膜切开术被证明是治疗痉挛型脑瘫患者膝屈肌挛缩的一种良好选择。
