Bozinovski Zoran, Popovski Neron
University Clinic for Orthopedic Surgery, Skopje, Republic of Macedonia.
Med Arch. 2014 Jun;68(3):182-3. doi: 10.5455/medarh.2014.68.182-183. Epub 2014 May 31.
Knee flexion is one of the main problems of the lower extremities in cerebral palsy patients. Many operative procedures are recommended for contractures of the knee in cerebral palsy patients. We performed simple operation and analyzed the results after operative treatment with nine years follow up.
85 patients with spastic cerebral palsy were treated in period 2001 - 2010. 40 were ambulatory and 45 non ambulatory with ability to stand with support. All of them underwent same surgical procedure with distal hamstrings lengthening. Tenotomies were performed on m. semitendinosus, m. semimembranosus, m. gracillis and biceps femoris. Only m. semitendinosus was tenotomized completely, other muscles were tenotomized only on tendinous part. The patients had a plaster immobilization for five days after the surgery with the knee extended.
All 85 patients had improvement of the popliteal angle pre and post operative respectively. Improvement in the crouch gait was noticed in the period of rehabilitation. We had no complication with the wound. Three of the patients had overcorrection and achieved recurvatum of the knees.
We consider this procedure very simple with satisfying improvement of standing, walking and sitting abilities in children with spastic cerebral palsy.
膝关节屈曲是脑瘫患者下肢的主要问题之一。对于脑瘫患者的膝关节挛缩，推荐了许多手术方法。我们实施了一种简单手术，并对手术治疗结果进行了九年的随访分析。
2001年至2010年期间，对85例痉挛性脑瘫患者进行了治疗。其中40例可独立行走，45例不能独立行走但在支撑下能够站立。所有患者均接受了相同的手术，即腘绳肌远端延长术。对半腱肌、半膜肌、股薄肌和股二头肌进行了肌腱切断术。仅完全切断了半腱肌，其他肌肉仅在肌腱部分进行了切断。术后患者膝关节伸直位石膏固定五天。
85例患者术后腘窝角均较术前有所改善。在康复期间，蹲伏步态也有改善。伤口无并发症。3例患者出现过度矫正，膝关节出现反屈。
我们认为该手术非常简单，能使痉挛性脑瘫患儿的站立、行走和坐立能力得到令人满意的改善。
