Аннотация
PURPOSE OF THE STUDY: The aim of the study was to demonstrate the
outcomes of video-assisted tenotomy of the gastrocnemius and soleus
muscles in children with the spastic form of cerebral palsy. MATERIAL:
In the period from September 2003 to March 2004, 18 lower extremities
in 14 patients were operated on.A set for endoscopic plastic surgery
with a 4-mm trocar was used. Aponeurotomy was carried out with a
scalpel no. 11 or arthroscopic scissors. The treated limb was immobilized
in plaster cast for 6 weeks. METHODS The inclusion criteria were:
an equinus gait free from a valgus or a varus deviation, preferably
unilateral, and the age range between 4 and 10 years. The patients
were examined before surgery and followed up at 3-month intervals.
RESULTS: In 16 out of 18 treated extremities, simple aponeurotomy
of the gastrocnemius and soleus muscles was sufficient to achieve
20 degrees dorsiflexion. In two cases it was necessary to complete
the procedure at the same stage by video-assisted sliding double-point
tenotomy of the Achilles tendon. The short-term follow-up did not
reveal complications such as failure of wound healing or neurological
or vascular disturbance. DISCUSSION: The international literature
data show that this method has largely been developed on cadavers.
Much attention has been given to potential injury to the sural nerve.
However, the ultimate goal of this operation, i. e., sufficient correction,
should be regarded as a much more important factor. In older children,
simple aponeurotomy may not achieve this objective and therefore
the authors developed a procedure combining video-assisted aponeurotomy
with sliding double-point tenotomy of the Achilles tendon. CONCLUSIONS:
Video-assisted tenotomy of the gastrocnemius and soleus muscles proved
a fully effective method in our group evaluated at short-term follow-up.
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