PDF(Pubmed)
Abstract：
OBJECTIVE: The aim of this study was to determine the intraoperative corrective effect of the aponeurotic release of semimembranosus (SM) as a single procedure or an adjunct procedure to distal myotendinous release of semitendinosus (ST) and myofascial release of SM lengthening in the correction of knee flexion deformity in cerebral palsy (CP).
METHODS: In this prospective study, 46 knees of 23 consecutive ambulatory patients (15 boys and 8 girls; mean age=8.33 years; age range=5-12 years) with spastic diplegic CP with a gross motor function classification system level (GMFCS) II or III were included. The patients were then divided into 2 groups. In group I, there were 10 patients (4 boys, 6 girls; mean age=8.6±2), and combined release of ST in the myotendinous junction and SM in the myofascial junction, followed by aponeurotic release of SM were carried out. In group II, there were 13 patients (2 girls, 11 boys; mean age=8±2.35), and aponeurotic release of SM was done first and followed by the combined release of ST in the distal myotendinous junction and the myofascial release of SM. Intraoperative popliteal angle (PA) measurements were recorded in each group.
RESULTS: PA was reduced from 58.1°±7.6° (range=46°-75°) to 41.2°±8.8° (range=20°-54°) in group 1 and from 59.1°±11.3° (range=40°-87°) to 42.7°±10.8° (range=24°-64°) in group 2. No significant difference was observed between the groups in terms of reduction in PA (p=0.867). In group 1, adding the aponeurotic release of SM further reduced the PA to 31.7°± 8.5° (range=14°-47°) (p=0.002). In group 2, adding the myotendinous release of ST and myofascial release of SM further reduced the PA to 32.9°±7.2° (range=16°-44°) (p=0.004). There was no significant difference between the final PA values in the 2 groups (p=0.662). There was no difference in terms of early complications.
CONCLUSIONS: Aponeurotic release of SM is equally effective to reduce the intraoperative PA with combined myotendinous release of ST and myofascial release of SM. Combining all the 3 procedures provides a better correction without forceful manipulation or lengthening of the lateral hamstrings during the correction of knee flexion deformity in CP.
METHODS: In this prospective study, 46 knees of 23 consecutive ambulatory patients (15 boys and 8 girls; mean age=8.33 years; age range=5-12 years) with spastic diplegic CP with a gross motor function classification system level (GMFCS) II or III were included. The patients were then divided into 2 groups. In group I, there were 10 patients (4 boys, 6 girls; mean age=8.6±2), and combined release of ST in the myotendinous junction and SM in the myofascial junction, followed by aponeurotic release of SM were carried out. In group II, there were 13 patients (2 girls, 11 boys; mean age=8±2.35), and aponeurotic release of SM was done first and followed by the combined release of ST in the distal myotendinous junction and the myofascial release of SM. Intraoperative popliteal angle (PA) measurements were recorded in each group.
RESULTS: PA was reduced from 58.1°±7.6° (range=46°-75°) to 41.2°±8.8° (range=20°-54°) in group 1 and from 59.1°±11.3° (range=40°-87°) to 42.7°±10.8° (range=24°-64°) in group 2. No significant difference was observed between the groups in terms of reduction in PA (p=0.867). In group 1, adding the aponeurotic release of SM further reduced the PA to 31.7°± 8.5° (range=14°-47°) (p=0.002). In group 2, adding the myotendinous release of ST and myofascial release of SM further reduced the PA to 32.9°±7.2° (range=16°-44°) (p=0.004). There was no significant difference between the final PA values in the 2 groups (p=0.662). There was no difference in terms of early complications.
CONCLUSIONS: Aponeurotic release of SM is equally effective to reduce the intraoperative PA with combined myotendinous release of ST and myofascial release of SM. Combining all the 3 procedures provides a better correction without forceful manipulation or lengthening of the lateral hamstrings during the correction of knee flexion deformity in CP.
摘要：
目的：本研究的目的是确定半膜腱膜（SM）作为单一手术或辅助手术的术中矫正效果，以矫正半膜腱肌远端肌腱肌释放（ST）和肌筋膜释放SM延长术中矫正脑瘫（CP）的膝关节屈曲畸形。
方法：在这项前瞻性研究中，包括23名连续卧床患者的46个膝盖（15个男孩和8个女孩；平均年龄=8.33岁；年龄范围=5-12岁），具有粗大运动功能分类系统水平（GMFCS）II或III。然后将患者分为两组。在第一组中,有10名患者(4名男孩，女孩6名；平均年龄=8.6±2），肌腱交界处的ST和肌筋膜交界处的SM的联合释放，然后进行SM的腱膜释放。在第二组中，有13名患者(2名女孩，11名男孩；平均年龄=8±2.35），首先进行SM的膜膜释放，然后在远端肌腱交界处联合释放ST和SM的肌筋膜释放。记录每组的术中pop角（PA）测量值。
结果：第1组PA从58.1°±7.6°（范围=46°-75°）降至41.2°±8.8°（范围=20°-54°），第2组PA从59.1°±11.3°（范围=40°-87°）降至42.7°±10.8°（范围=24°-64°）。两组间在PA降低方面没有观察到显著差异(p=0.867)。在第1组中，添加SM的腱膜释放进一步将PA降低至31.7°±8.5°（范围=14°-47°）（p=0.002）。在第2组中，添加ST的肌腱释放和SM的肌筋膜释放进一步将PA降低至32.9°±7.2°（范围=16°-44°）（p=0.004）。两组的最终PA值之间没有显着差异（p=0.662）。在早期并发症方面没有差异。
结论：SM的膜膜释放与ST的肌腱释放和SM的肌筋膜释放对减少术中PA同样有效。在CP膝关节屈曲畸形的矫正过程中，结合所有3种程序可提供更好的矫正，而无需用力操纵或延长外侧腿筋。
方法：在这项前瞻性研究中，包括23名连续卧床患者的46个膝盖（15个男孩和8个女孩；平均年龄=8.33岁；年龄范围=5-12岁），具有粗大运动功能分类系统水平（GMFCS）II或III。然后将患者分为两组。在第一组中,有10名患者(4名男孩，女孩6名；平均年龄=8.6±2），肌腱交界处的ST和肌筋膜交界处的SM的联合释放，然后进行SM的腱膜释放。在第二组中，有13名患者(2名女孩，11名男孩；平均年龄=8±2.35），首先进行SM的膜膜释放，然后在远端肌腱交界处联合释放ST和SM的肌筋膜释放。记录每组的术中pop角（PA）测量值。
结果：第1组PA从58.1°±7.6°（范围=46°-75°）降至41.2°±8.8°（范围=20°-54°），第2组PA从59.1°±11.3°（范围=40°-87°）降至42.7°±10.8°（范围=24°-64°）。两组间在PA降低方面没有观察到显著差异(p=0.867)。在第1组中，添加SM的腱膜释放进一步将PA降低至31.7°±8.5°（范围=14°-47°）（p=0.002）。在第2组中，添加ST的肌腱释放和SM的肌筋膜释放进一步将PA降低至32.9°±7.2°（范围=16°-44°）（p=0.004）。两组的最终PA值之间没有显着差异（p=0.662）。在早期并发症方面没有差异。
结论：SM的膜膜释放与ST的肌腱释放和SM的肌筋膜释放对减少术中PA同样有效。在CP膝关节屈曲畸形的矫正过程中，结合所有3种程序可提供更好的矫正，而无需用力操纵或延长外侧腿筋。
