RU2417795C1 - Method of treating dynamic equino-plano-valgus deformation of foot in children with icp - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, in particular to orthopedics, and deals with treatment of dynamic equino-plano-valgus deformation of foot in children with infantile cerebral paralysis. For this purpose, if associated pathological motor stereotype of hip and shin muscles is detected carried out are injections of Disport medication, both into triceps muscle of shin, and into thigh adductors, shin flexors and peroneal muscles. Total medication dose constitutes 30 units per weight kilogram, but not more than 1000 units. 50% of dose are introduced in triceps muscle of shin, by 20% of dose - into thigh adductors and shin flexors and 10% - in peroneal muscles. Repeated injections are carried out according to the same scheme after 4-6 months. ^ EFFECT: method insures efficient treatment due to direct reduction of hypertone of muscles, which cause foot deformation, reduction of tibial synkinesis, which is basic mechanism of deformation pathogenesis, as well as evening-out of pathological pose, which assists progression of pathological foot setting. ^ 9 dwg

Description

The invention relates to medicine, namely to orthopedics.

Known methods for treating dynamic foot deformities in children with cerebral palsy by injecting botulinum toxin into the calf muscles (Koman L., Brashear A., Rosenfeld S., Chambers H., Russman B., Rang M. et al. Botulinum Toxin Type A neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open-label clinical trial. Pediatrics 2001; 108: 1062-1071). However, with equino-valgus deformity of the foot, a decrease in the tonus of the triceps muscle of the leg leads to an aggravation of the plano-valgus component of the deformation (Sutherland D., Kaufman K., Wyatt M., Chambers N. Injection of botulinum A toxin into the gastrocnemius muscle of patients with cerebral palsy: a 3-dimensional motion analysis study. Gait Posture 1996; 4: 269-279).

It is also known that spastic equino-valgus deformity of the foot is formed by combining hypertonicity of the triceps tibia and fibula, the leading mechanism of formation of which is tibial synkinesia, which consists in the simultaneous contraction of these muscles during spastic flexion in the hip and knee joints, leading to the installation of the val feet (Semenova K.A. Restorative treatment of patients with the residual stage of cerebral palsy. - M .: Antidor, 1999. - 384 s). In addition, an increase in muscle tone of the tibia flexors leads to the formation of a pathological installation consisting in aggravation of flexion of the knee joints, and the formation of secondary calcaneal installations of the feet, and the adduction of the hips aggravates the hallux valgus component (Features of the complex orthopedic surgical treatment of children with cerebral palsy: Manual for doctors / A .P. Kutuzov; NIDOI named after G.I. Turner. - St. Petersburg, 1997. - 28 s).

The objective of this method is to improve the results of treatment of dynamic equino-valgus deformity of the foot in children with cerebral palsy.

The technical solution of this problem is achieved by the fact that when a friendly pathological motor stereotype of the thigh and lower leg muscles is detected in a child with dynamic equino-valgus deformity of the foot, Dysport injections are performed both in the triceps tibialis muscle and in the adductors of the thighs, flexor muscles shins and peroneal muscles.

Figure 1 presents a view of a child with a cross of the lower extremities when walking.

Figure 2 presents a view of a child with incomplete extension of the leg in a standing position.

Figure 3 presents the view of the foot with tibial synkinesia.

Figure 4 presents the points of introduction of Dysport into the triceps muscle of the leg.

Figure 5 presents the point of introduction of Dysport into the peroneal muscles.

Figure 6 presents the points of introduction of Dysport into the adductor muscles of the thigh.

7 shows the points of introduction of Dysport into the flexors of the lower leg.

On Fig presents the appearance of the feet of the child before treatment.

Figure 9 presents the appearance of the feet of the child after treatment.

The method is as follows.

A child is examined in a standing position and while walking, while the position of the foot and the nature of the movements in the hip and knee joints are noted. Then, during a clinical examination in the supine position, the range of motion in the hip and knee joints is determined and a test with active flexion of the lower leg is performed. In this case, the presence of the following possible changes is noted:

1. Bringing and crossing the lower limbs when walking and increasing the tone of the adducting mouse, thighs in a prone position (figure 1).

2. Incomplete extension of the lower leg in the standing position and when walking in the supporting phase of the step and flexion installation in the knee joint in the supine position (figure 2).

3. Tibial synkinesia (figure 3).

When these manifestations are combined with spastic equino-valgus deformity of the foot, Dysport is injected into the triceps muscle of the lower leg, as well as into the peroneal muscles, leading the femoral and flexor muscles of the lower leg.

In the supine position, the patient is treated with an antiseptic solution of the inner thighs. Dysport is injected with insulin syringes with a volume of 1 milliliter and a needle 2 cm long. Injection into the long adductor muscle and slender muscle is performed to a depth of 1-1.5 cm at a distance of 5-7 cm distal to the inguinal fold, one injection point at each two muscles on each side (Fig.6). Then, in the position of the patient lying on his stomach, an antiseptic solution is applied to the back of the thighs and the back and outer surfaces of the legs. The drug “Dysport” is injected into the flexors of the lower leg at the border of the upper and middle third of the thigh, as well as at the border of the middle and lower third of the thigh to a depth of 1-2 cm (Fig. 7). Then, the drug “Dysport” is injected into the triceps muscle of the lower leg in the upper third of the lower leg at two points at a distance of 2-3 cm parasagittally to a depth of 1-1.5 cm (figure 4). After that, the drug “Dysport” is injected into the peroneal muscles at the border of the upper and middle third of the tibia along the lateral surface to a depth of 1 cm (Fig. 5).

A preliminary calculation of the doses of the drug administered is as follows. The total dosage of the drug is 30 units per 1 kilogram of weight, but not more than 1000 units. Of the total dose of the drug, 50% is injected into the calf muscles, 20% into the adductors of the thighs, 20% into the flexors of the leg and 10% into the peroneal muscles.

Repeated injections are made after 4-6 months according to the same scheme.

Equino-valgus deformity of the feet in children with cerebral palsy remains one of the most difficult problems of orthopedics of cerebral palsy (Fig. 8). The proposed method leads both to a direct decrease in muscle hypertonicity, causing spastic equino-plano-valgus deformity of the foot, and to a decrease in tibial synkinesia, which is the main mechanism of the pathogenesis of deformation, as well as the leveling of the pathological posture, which consists in bringing the hips and flexion of the legs and contributing to the progression of pathological settings of the feet, thereby increasing the effectiveness of treatment (Fig.9).

Claims (1)

A method of treating dynamic equino-valgus deformity of the foot in children with cerebral palsy, including injections of the Dysport preparation, characterized in that when a friendly pathological motor stereotype of the thigh and lower leg muscles is detected, the drug is injected into the triceps tibialis muscle as well as into the adductors hips, muscles of the leg flexors and peroneal muscles, the total dose of the drug is 30 units per kilogram of weight, but not more than 1000 units, while 50% of the dose is injected into the triceps muscle of the lower leg, 20% of the dose into the adductors the hips and muscles are flexors of the lower leg and 10% in the peroneal muscles, repeated injections are carried out according to the same scheme after 4-6 months.

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