Acta Chir Orthop Traumatol Cech. 2003; 70(4):237-242
[Causes of development of genu recurvatum after surgical treatment in spastic forms of childhood cerebral palsy].
- Klinika dĕtské chirurgie, ortopedie a traumatologie, Dĕtská nemocnice FN, Brno. jpoul@med.muni.cz
PURPOSE OF THE STUDY: To evaluate the contribution of different surgical techniques of lengthening of distal hamstrings on the development of hyperextension deformity of the knee in spastics.
MATERIAL: Totally 51 patients of age 7.6 + 3.7 years at operation. Follow-up after surgical release for 4-10 years. Basically two surgical techniques were used: 1. Simple division of gracilis and semitendinosus, fractional lengthening of semimembranosus and biceps femoris. 2. Gracilis and semitendinosus were anchored after its transverse division to fractionally lengthened semimembranosus.
METHODS: Pre-operative and post-operative Bleck popliteal angles were estimated. Hyperextension was tested in lying and standing positions.
RESULTS: Type of surgery (1 or 2) did not influence the development of hyperextension deformity of the knee (tested by Fisher exact test). Nevertheless the relation between type of surgery (1 or 2) and the stratified value of Bleck popliteal angle was statistically significant. In the subgroup 2, in which the superficial tendons were anchored to semimebraneous, the occurrence of values of Bleck angle less than 20 degrees, was lower than in the subgroup 1.
DISCUSSION: It seems, that the type of described two different surgical techniques is not so much decisive for development of hyperextension deformity.
CONCLUSION: Authors surmise, that principal role play stronger deep knee flexors (semimembranosus and biceps femoris). Its fractional lengthening must be very careful.
Zveřejněno: 23. říjen 2003 Zobrazit citaci