2 English Reference Neurology Tibetan Neurofungal Branch
Surgical name: tibial neuromuscular incision
Classification 4 Orthopedics/Spastic Paralysis Surgery/Surgical Treatment of Spastic Foot Drop
5 ICD coding 04.03
To summarize the treatment of spastic foot drop by amputation of tibial nerve muscle branch. In childhood, horseshoe foot can be corrected by manipulation, muscle spasm can be relieved by pulling triceps and splint can be corrected intermittently or continuously in functional position, and plaster can also be used for correction. The ankle joint can be fixed in the functional position for 3 weeks, and then splint can be used at night. When conservative treatment fails or deformity is serious, surgery can be considered, but the minimum age of surgery must be over 7 ~ 8 years old.
Older children or adults, non-surgical treatment is rarely successful, usually surgical treatment. The commonly used methods for surgical correction of spastic foot drop include gastrocnemius tendon peeling and loosening, achilles tendon lengthening, soleus motor nerve branch amputation and external fixation of three joints and subtalar joint.
The anatomy related to the operation is shown in the following figure (Figure 3.24.1.1,3.24. 1. 12).
Indications: Myobranch amputation of tibial nerve is suitable for ankle clonus caused by triceps spasm of calf.
Preoperative preparation 1. Check carefully before operation to determine whether the clonus is caused by gastrocnemius or soleus. If it is caused by gastrocnemius muscle, the clonus will be relieved or disappeared when the knee joint flexes 90; If it is caused by soleus muscle, knee flexion clonus will not be relieved. The former requires double head dissection of gastrocnemius muscle, while the latter requires amputation of soleus muscle branch of tibial nerve.
2. Before operation, the treatment plan, treatment results and postoperative functional training should be explained in detail to patients and their families, so as to strive for patients' cooperation with treatment.
9 anesthesia and * * * choose spinal anesthesia, epidural anesthesia or local anesthesia. Lying position or lateral position.
10 surgical procedures 10. 1. Incision Make a longitudinal S-shaped incision in the popliteal fossa, with a length of 3 ~ 4 cm, and cut the skin and subcutaneous tissue.
10.2 2. Expose the deep fascia and expose the tibial nerve, which is located on the superficial surface of popliteal fossa. The tibial nerve 1 branch is a cutaneous sensory branch, which is not treated; The following two branches are motor branches, which are located inside and outside the nerve trunk respectively. The medial branch enters the medial head and the lateral branch enters the lateral head (Figure 3.24. 1. 13). These two branches enter the muscles near the two ends of gastrocnemius. Before entering the muscle, the medial branch is divided into three branches, and the lateral branch is divided into two branches. Before the small branch, a soleus muscle branch was branched from the distal posterior side of the tibial nerve and divided into two branches, which entered the medial head and lateral head of the soleus muscle respectively. There is also a branch at the distal end that enters the soleus muscle. Clamp each neuromuscular branch with electric current or flat-headed tweezers to determine the degree of spasm and ankle clonus, then cut off the selected branch from the starting point of the trunk and remove the distal end from the muscle.
10.3 3. Suture the incision, loosen the tourniquet, stop bleeding, flush the incision with isotonic saline, and suture in layers.
Precautions in operation 1 1. When separating and looking for neuromuscular branches, be careful not to damage popliteal vessels.
2. Just cut off the 1 ~ 2 muscle branch, and don't cut off too much to prevent the foot muscle strength from weakening.
Postoperative management of 12