Caillet F, Mertens P, Rabaseda S, Boisson D
Service de Rééducation Fonctionnelle, Hôpital Henry-Gabrielle, Saint-Genis-Laval.
Neurochirurgie. 1998 Sep;44(3):183-91.
Spastic Foot may constitute a severe functional deficit leading to instability in stance and inappropriate prepositioning of the foot for its initial contact with the ground. The purpose of the study was to analyze the results of selective tibial neurotomy on gait.
After clinical examination of nine hemiplegic patients, gait was recorded before surgery and six months after. Three-dimensional bilateral kinematic data were obtained with a motion measurement system (VICON), and muscular electrical activity on affected side was detected with surface electrodes. The patient walked barefoot, with his free velocity, on a ten meter track in the lab. An analogic visual scale was used by the patient to evaluate gait discomfort.
After neurotomy, triceps surae spasticity decreased and passive motion of ankle increased. Gait comfort was better, claw toes and sore skin disappeared. Kinematics data were modified by neurotomy in all patients. On the affected side, ankle dorsiflexion improved during stance for five patients and residual motricity improved during the swing phase for two patients. Stance knee hyperextension was corrected in the five patients. EMG data: Selective tibial neurotomy caused disappearance of triceps surae peak activity at the beginning of the stance phase and at the end of swing phase. The time activity of the other muscles did not change.
Selective tibial neurotomy can cure foot deformity and modify ankle motion during gait. It corrects knee hyperextension during stance phase.
痉挛性足可能构成严重的功能缺陷，导致站立时不稳定以及足部在初次接触地面时的预定位不当。本研究的目的是分析选择性胫神经切断术对步态的影响。
对9例偏瘫患者进行临床检查后，记录手术前及术后6个月的步态。使用运动测量系统（VICON）获取三维双侧运动学数据，并用表面电极检测患侧的肌肉电活动。患者在实验室的10米跑道上赤足以自由速度行走。患者使用模拟视觉量表评估步态不适。
神经切断术后，小腿三头肌痉挛减轻，踝关节被动活动增加。步态舒适度提高，爪形趾和皮肤疼痛消失。所有患者的运动学数据均因神经切断术而改变。在患侧，5例患者在站立期踝关节背屈改善，2例患者在摆动期残余运动改善。5例患者站立时膝关节过伸得到纠正。肌电图数据：选择性胫神经切断术导致小腿三头肌在站立期开始和摆动期结束时的峰值活动消失。其他肌肉的时间活动没有变化。
选择性胫神经切断术可治愈足部畸形并改变步态期间的踝关节运动。它可纠正站立期膝关节过伸。
