SU897229A1 - Method of transplanting musle tendons at child cerebral paralisis - Google Patents

Description

(54) METHOD FOR RESEARCHING OF THE MUSCLE TONES IN CHILDREN'S CEREBRAL PARALYSIS

I

The invention relates to medicine, in particular to methods for the surgical treatment of diseases of the musculoskeletal system.

There is a method of muscle tendon transplantation in cerebral palsy, which provides for the application of marks on the skin and abdomen of the muscle allocated for transplantation and fixation of the tendons 1.

However, the use of the known method in infantile cerebral palsy in conditions of minuscule hypertonus leads to the limitation of flexion in the knee joint and impaired motor function of coichiness as a whole due to the insufficient length of the transplanted muscles and weakness of the overgrown proper bow of the bend, as well as the high displacement of the latter.

The aim of the invention is to increase the volume of the active flexor at the knee joint and to restore the coagrulence of the articular surfaces of the bend and the femur.

The goal is achieved by the fact that, according to the method of transplanting muscle tendons in cerebral palsy,

marking marks on the skin and abdomen of the muscle to be transplanted and tendon fixation, the tendon of the transplanted muscle is fixed in the splitting of the tendons of the quadriceps muscle of the hip joint bent 130-150 ° and so that the mark on the muscle is 1-1.5 cm from marks on the skin, then the lower leg is straightened, the patellar is maximally low, the distal end of the tendons of the transplanted muscle is held

through the thickness of the intrinsic ligament of the patella, and the latter is reinforced by the shirring of the tendon tissue.

The method is carried out as follows.

A linear incision is made along the posterior posterior thigh surface from the border of the middle and lower third to the head of the fibula 14 cm long. The tendon of the long head of the biceps of the thigh is mobilized up to the middle third of the thigh and down to the head of the fibula. Then the distal end of the tendon is extended by fascia 6-8 cm. The integrity of the anatomical bed is restored. In the same way, the distal end of the tendons of the semitendinosus or delicate mice on the inner side of the thigh are isolated for transplantation and lengthened. A patella is exposed through a linear skin incision along the anterior surface of the knee joint, it is sawed in the frontal plane, and in the same plane, the quadriceps of the femur is split 4-6 cm upward in the posterior cusp of the patella to form a bone method. In the subcutaneous tissue of the first and second paradise in the direction of the third form. They carry the tendons of the transplanted muscles. The lower leg is bent to an angle of 130-150 °, the tendons held are tensioned until the distance between the control marks on the muscle and the skin is not 1-1.5 cm. The transplanted tendons are sutured with catgut sutures in the cleft C5, and the neck muscle of the patella and among themselves. Thereafter, the calf is straightened, the patella is mixed as much as possible downward, the distal ends of the tendons being transplanted are passed through the thickness of the patellar proper ligament. The latter is reinforced by a crimped living tendon tissue. Wounds are sutured in layers tightly. A large hip dressing is applied for 6 weeks. After removal of the plaster dressing, a course of conservative treatment (muscle massage, exercise therapy, warm baths, copper stone products) is carried out, aimed at developing a new function of the transplanted mouse and improving the function of the operated limb. Example 1: Patient Ya.S., 14 years old, diagnosis: cerebral palsy, S1 amid shape, flexion-causing contractures in the joints of the lower extremities. A double-sided adduct of augmentation procedure, closed with an asthma astika, transplantation of a long head of the two-headed and delicate mice on the left is performed. Linear incision 12 cm in length on the posterior surface of the left femur of the head of the fibula. The head of the biceps femoris was isolated and mobilized, the distal part of its tendon was untreated 6 cm due to fascial stretching of the lower leg. A silk-colored silk ligature is stitched onto the skin’s upper edge of the surgical wound. A similar ligature from catgut is stitched to the neck of the neck and we are on the same level. The end of the tendons is clipped. Restored anatomical bed. A similar skin incision along the inside of the left thigh. The tendon of the semitendinosus muscle is injected, its distal end is lengthened by 5 cm due to the tendon stretch of the surfaces of the goose foot. Similarly, control strings are applied to the skin and muscles. The tendon 4 is cut off. The third is a skin incision on the front surface of the knee joint 10 cm long. The patella is mobilized, sawn in the frontal plane, and the quadriceps tendon is split up on the same plane. 8 cm. A bone chute is formed in the posterior cusp of the patella, into which the tendons of the long head of the biceps and semitendinosus muscles, which are taken for transplantation, are drawn and laid. The latter are stitched with catgut in the criss-cross of the quadriceps and patella with the tibia bent to 130 °. The control mark on the muscle is not dot-chick to 1.5 cm on the skin. The lower leg is fully extended, the patella is as ridiculous as possible. The distal ends of the transplanted tendons are passed through the thickness of the intrinsic ligament of the patella with its shirring and are reinforced into the bone canal of the tibial tuberosity. The wounds are sutured in layers tightly. After 4 weeks of taking out the gypsum dressing, the development of a new function of the transplanted muscles was continued. At present, the child walks by himself, contractures in the joints of the lower limbs are eliminated, the function of the operated limbs is good. The results of the operation the patient and parents are satisfied. Example 2. Sick K.I., 22 years old, diagnosis: cerebral palsy, spastic lower paraparesis, flexion-curing contractures in the joints of the lower extremities. The operation was performed: bilateral adductoroplasty, bilateral achilloplasty closed, transplantation of the long head of the biceps and the semitendinosus muscles to the tuberosity of the tibia on the right. During the operation, the proposed method of muscle tendon transplantation in cerebral palsy was used. The postoperative period was uneventful. The results of the operation are ill. Example 3. Patient A. A., 16 years old, diagnosed with cerebral palsy, spastic tetraparesis, positive-limiting contractures in the joints of the lower extremities. The operation was carried out: the double-sided closed achillo-plastic, double-sided adductoplasty, transplantation to the floor of the tendonal head of the biceps to the tibial tuberosity on the left. During the operation, the proposed method of sukhokkL muscle transplantation was applied. The results of the operation are good. Thus, the proposed method makes it possible to increase the amount of active flexion in the knee joint by creating the necessary reserve of length of the transplanted tendons and to restore the congruence of the articular surfaces of the patella and femur.

Claims (1)

Invention Formula The method of transferring the tendons in cerebral palsy, which involves applying marks on the skin and abdomen of the muscle to be transplanted and fixing the muscle and fixing the tendons, in order to increase the amount of active flexion in the knee joint and restore the calchroence of the articular patella and femur tendon transplanted the muscles are fixed in the cleft tendon of the quadriceps muscle of the hip with the knee joint bent to 130-150 ° and so that the mark on the mouse is 11.5 cm from the mark on the skin, then the lower leg is straightened, the patella is maximally lowered, the distal end The tendons of the transplanted bone are guided through the thickness of the patellar ligament of their own, and the latter is reinforced by corrugation with a tendon tissue. Sources of information taken into account in the examination 1. Chaklin V. D. Fundamentals of operative traumatology and orthopedics. M., Medicine, 1964, p. 621.