Keenan M A
Adult Brain Injury Service, Rancho Los Amigos Medical Center, Downey, California.
Orthop Rev. 1988 Dec;17(12):1185-92.
When neurologic recovery has plateaued following traumatic brain injury, careful assessment is needed prior to making surgical decisions to correct residual limb deformities. Sufficient cognition to follow simple commands, cooperate with postoperative therapy, and benefit from improved function is essential. Sensation must also be intact. Motor control of the extremity can be evaluated by clinical examination supplemented by nerve blocks to relieve spasticity in antagonistic muscle groups. Dynamic electromyography is frequently required for surgical decision making. Hand placement may be deterred by spasticity of the brachioradialis, biceps, and brachialis muscles. Active finger extension may be masked by spastic flexors. In the lower extremity, knee flexion may be blocked during the preswing period by inappropriate firing of one or more components of the quadriceps. The equinovarus deformity of the foot is the result of spasticity of the gastrocsoleus muscles, the toe flexors, and the tibialis anterior.
当创伤性脑损伤后的神经功能恢复达到平台期时，在做出纠正残留肢体畸形的手术决策之前，需要进行仔细评估。具备足够的认知能力以遵循简单指令、配合术后治疗并从功能改善中获益至关重要。感觉也必须完好无损。肢体的运动控制可通过临床检查进行评估，并辅以神经阻滞以缓解拮抗肌群的痉挛。手术决策通常需要动态肌电图检查。肱桡肌、肱二头肌和肱肌的痉挛可能会妨碍手部放置。主动手指伸展可能会被痉挛性屈肌掩盖。在下肢，股四头肌的一个或多个组成部分在摆动前期不适当的放电可能会阻碍膝关节屈曲。足内翻畸形是腓肠肌、趾屈肌和胫前肌痉挛的结果。
