Spastic equinus foot: Multicenter study of the long-term results of tibial neurotomy

被引:41
作者
Buffenoir, K
Roujeau, T
Lapierre, FO
Menei, P
Menegalli-Boggelli, D
Mertens, P
Decq, P [1 ]
机构
[1] Hop Henri Mondor, Assistance Publ Hop Paris, Serv Neurochirurg, F-94010 Creteil, France
[2] CHU La Miletrie, Serv Neurochirurg, F-86021 Poitiers, France
[3] CHU Angers, Serv Neurochirurg, Angers, France
[4] CHU Nantes, Serv Neurochirurg, F-44035 Nantes 01, France
[5] Ctr Hosp Univ, Hop Wertheimer, Serv Neurochirurg, Lyon, France
关键词
functional neurosurgery; gait analysis; neurotomy; peripheral nerves; spasticity; stretch reflex;
D O I
10.1227/01.NEU.0000140840.59586.CF
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: Tibial neurotomy is a surgical technique widely used for the treatment of spastic equinus foot, but, it has rarely,been evaluated. The primary objective of this prospective study was to provide an objective quantification of the long-term results of tibial neurotomy. METHODS: This multicenter prospective study was conducted from 1999 to 2003. Fifty-five patients with spastic equinus foot were treated in five neurosurgical centers. Preoperative and postoperative clinical evaluation comprised description of the foot deformity, study of stretch reflexes, evaluation of the repercussions of the deformity, and gait analysis. Selective neurotomy was performed in all patients. RESULTS: No postoperative complications were observed. The mean postoperative follow-up was 10 months. Tibial, neurotomy improved the appearance of the foot (equinus and, varus deformities, claw toes); the equinus score decreased from 1.54 to 0.273 after the operation. Stretch reflex scores were decreased significantly and for a long term after surgery; the mean triceps surae stretch reflex score decreased from 2.46 to 0.47. The angle of passive dorsiflexion of the ankle increased significantly (from 0.56 degrees to +6.85 degrees). Gait analysis demonstrated a statistically significant increase in the speed of the patient's gait after surgical treatment; the time taken by the patient to walk 10 m at a normal speed in shoes decreased from a mean of 55 seconds to 35.16 seconds. postoperatively, 92.7% of preoperative objectives had been achieved. CONCLUSION: Tibial neurotomy ensures long-term functional improvement of patients with spastic equinus foot. It provides a lasting response for these patients compared with other, more transient treatments.
引用
收藏
页码:1130 / 1136
页数:7
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