Cottalorda J, Gautheron V, Charmet E, Chavrier Y
Service de Chirurgie Infantile, Hôpital Nord, Saint-Etienne.
Rev Chir Orthop Reparatrice Appar Mot. 1997;83(4):368-71.
Twenty children with cerebral palsy who underwent elongation of the triceps surae using successive plaster-casts (28 short triceps) were reviewed. This study was retrospective.
Among the eighteen children, 10 were hemiplegic, 8 were diplegic and 2 were spastic quadriparetic. All of them except one were ambulatory children. The authors describe their elongation technique by plaster-casts and the treatment they lead. The mean age at time of elongation was 4 years and 6 months (range 2 years 4 months to 8 years). The passive dorsiflexion of the foot before elongation was of 0 degree (range -20 degrees to +10 degrees) knee in extension, and of 5 degrees (range -15 degrees to +15 degrees) knee in flexion.
The passive dorsiflexion of the foot after elongation was of 23 degrees (range +10 degrees to +30 degrees) knee in extension, and of 27 degrees (range +10 degrees to +35 degrees) knee in flexion. One major complication was noted: the persistence of a varus foot in child after elongation. 24 elongations were reviewed with a mean follow-up of 21 months (range 12 months to 30 months). The passive dorsiflexion of the foot was of 10 degrees (range 0 degree to +20 degrees) knee in extension and of 17 degrees (range -5 degrees to +25 degrees) knee in flexion.
Compared to different procedures (surgical lengthening, botulinum-A toxin) elongation by successive plaster-casts is a quick, safe, complication-free, and simple technique, whose results are equivalent. Even if recurrence of equinus is probable, a surgical procedure of lengthening could be made on an operative-free tendon.
Elongation of the triceps surae muscle by successive plaster-casts constitutes a safe alternative technique compared to surgical procedure.
回顾20例采用连续石膏固定法进行小腿三头肌延长术的脑瘫患儿（28条短缩的小腿三头肌）。本研究为回顾性研究。
18例患儿中，10例为偏瘫型，8例为双瘫型，2例为痉挛性四肢瘫型。除1例患儿外，其余均为能行走的儿童。作者描述了他们采用石膏固定的延长技术及所进行的治疗。延长术时的平均年龄为4岁6个月（范围为2岁4个月至8岁）。延长术前，膝关节伸直时足部被动背屈角度为0度（范围为-20度至+10度），膝关节屈曲时为5度（范围为-15度至+15度）。
延长术后，膝关节伸直时足部被动背屈角度为23度（范围为+10度至+30度），膝关节屈曲时为27度（范围为+10度至+35度）。记录到1例主要并发症：延长术后患儿足部持续内翻。对24次延长术进行了回顾，平均随访21个月（范围为12个月至30个月）。膝关节伸直时足部被动背屈角度为10度（范围为0度至+20度），膝关节屈曲时为17度（范围为-5度至+25度）。
与不同的治疗方法（手术延长、A型肉毒毒素注射）相比，连续石膏固定延长术是一种快速、安全、无并发症且简单的技术，其效果相当。即使马蹄足复发可能性较大，但可在未手术的肌腱上进行延长手术。
与手术方法相比，连续石膏固定小腿三头肌延长术是一种安全的替代技术。
