Treatment Outcomes Of Tibial Neurotomy And Achilles Tendon Lengthening On Recurrent Achilles Tendon Contracture Of Cerebral Palsy

Objective: To observe the long term effect of tibial nerve branch resection and Achilles tendon lengthening in the treatment of patients with cerebral palsy with idiopathic Achilles tendon contracture.Methods: From September 2015 to September 2017,15 patients with contracture of Achilles tendon contracture underwent tibial nerve branch resection and Achilles tendon lengthening.Among them,male 9 cases,female 6 cases,right Achilles tendon contracture 10 cases,left Achilles tendon contracture 4 cases,bilateral Achilles tendon contracture 1 cases,the average age is 9.4 years old(3 years old),Patients with Achilles tendon contracture in the 3 months to 36 months have been in the local hospital has been extended Achilles tendon surgery,this is a secondary Achilles tendon contracture,found two times with Achilles tendon contracture to surgery time 3 months-9 months,the average 5.5 months,follow-up time: September 2015 to September 2017 total follow-up of 24 months,the average follow-up of 6 months.All patients underwent a detailed medical examination and assisted examination prior to surgery to clearly diagnose the idiopathic contracture of the Achilles tendon in cerebral palsy.15 patients were assessed by Russman-gage Standard: ? Grade 13 cases,? Grade 2 cases.The muscle tension of limb was graded according to Ashworth standard: 3 Grade 11 cases,4 grade 4 cases.Postoperative observation and evaluation of the recovery of the function of the ankle joint,excellent: the foot flat,can carry 5,walking without difficulty,foot appearance and normal gait,restore work,muscle tension is 0 to 1+ level;good: the foot is flat,the back extension has the difficulty,the foot appearance and the gait basically normal,the muscular tension at 2;,difficult to walk,muscle tension in the 2 level.Results: Of the 15 patients,1 patients were treated with the tibial nerve branch as a special type,and the branch of tibial nerve was narrowed.All patients were followed up for 6 months after the operation,with the foot flat,can carry 5°,walking without difficulty,foot appearance and gait normal,restore work,muscle tension is 0 to 1+ level 10 cases(71.43%),suffering from foot flat,back extension has difficulty,foot appearance and gait basic normal,muscular tension of 2 Class 2 cases(14.29%),suffering from the foot can not be flat,there are mild plantar flexion deformity,difficult to walk,muscle tension in the 2 level above 2 cases(14.29%).The fine rate accounted for 85.72%.Conclusion: The tibial nerve branch resection and the Achilles tendon lengthening for the treatment of cerebral palsy Achilles tendon contracture foot and ankle function reconstruction therapy is more positive,it is necessary to pay attention to the preoperative ankle function,muscular tension,the evaluation of traction reflex to determine the correct surgical plan.