Cormier Camille, Sourisseau Clément, Montane Emmeline, Scandella Marino, Castel-Lacanal Evelyne, Boissezon Xavier De, Marque Philippe, Gasq David
Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France.
ToNIC, Toulouse NeuroImaging Centre, Inserm, University of Toulouse 3, Toulouse, France.
Front Neurol. 2022 May 27;13:862644. doi: 10.3389/fneur.2022.862644. eCollection 2022.
Spastic equinus foot is a common deformity in neurologic patients who compromise walking ability. It is related to the imbalance between weak dorsiflexion and overactive plantar flexor muscles. To achieve the best functional results after surgical management, the challenge is to identify the relevant components involved in the deformity using several methods, namely, examination in the supine position, motor nerve blocks allowing transient anesthesia of suspected overactive muscles, and kinematic and electromyographic data collected during an instrumented 3D gait analysis. The procedure is not standardized; its use varies from one team to another. Access to gait analysis laboratories is limited, and some teams do not perform motor nerve blocks. When both examinations are available, instrumental data from the instrumented 3D gait analysis can be used to specify muscle targets for motor blocks, but data collected from both examinations are sometimes considered redundant. This retrospective cohort analysis compared examination in the supine position, temporary motor nerve blocks, and instrumented 3D gait analysis data in 40 adults after brain or spinal cord injuries. Clinical data collected before motor nerve block was not associated with instrumental data to assess calf muscle's overactivity and tibialis anterior function. Improvement of ankle dorsiflexion in the swing phase after tibial motor nerve block was associated with soleus spastic co-contraction during this phase corroborating its involvement in ankle dorsiflexion defects. This study showed the relevance of tibial motor nerve block to remove spastic calf dystonia and facilitate the assessment of calf contracture. It also underlined the need for complementary and specific analyses of the tibialis anterior abnormal activation pattern after motor nerve block to confirm or deny their pathological nature.
痉挛性马蹄内翻足是神经科患者中常见的一种畸形，会影响行走能力。它与背屈无力和跖屈肌过度活跃之间的失衡有关。为了在手术治疗后获得最佳功能效果，挑战在于使用多种方法来识别畸形中涉及的相关组成部分，即仰卧位检查、对疑似过度活跃肌肉进行短暂麻醉的运动神经阻滞，以及在仪器化三维步态分析过程中收集的运动学和肌电图数据。该程序并不标准化；不同团队的使用情况各不相同。步态分析实验室的使用受限，一些团队不进行运动神经阻滞。当两种检查都可用时，仪器化三维步态分析的仪器数据可用于确定运动阻滞的肌肉靶点，但有时认为两种检查收集的数据是多余的。这项回顾性队列分析比较了40名脑或脊髓损伤后的成年人的仰卧位检查、临时运动神经阻滞和仪器化三维步态分析数据。运动神经阻滞前收集的临床数据与评估小腿肌肉过度活跃和胫前肌功能的仪器数据无关。胫神经运动神经阻滞后摆动期踝关节背屈的改善与该阶段比目鱼肌痉挛性共同收缩有关，证实了其与踝关节背屈缺陷有关。这项研究表明胫神经运动阻滞对于消除痉挛性小腿肌张力障碍和促进小腿挛缩评估的相关性。它还强调了对运动神经阻滞后胫前肌异常激活模式进行补充和特异性分析的必要性，以确认或否定其病理性质。
