An initial report of transplantation of the adductor brevis and gracilis to treat scissors gait of spastic cerebral palsy / 中华骨科杂志

ABSTRACT

Objective To evaluate the effects of transplant adductor brevis and gracilis to correct scissors gait in spastic cerebral palsy. Methods From July 2000 to December 2004, 73 patients with scissors gait of spastic cerebral palsy were treated with transplantation of adductor brevis and gracilis, 47 were males and 26 were females, with the average of 12.06 years old. According to Ashworth's standard, the muscle tension was evaluated before surgery. 12 cases were in degree Ⅰ, 38 cases were in degreeⅡ, 18 cases in degree Ⅲ and 5 cases in degree Ⅳ. The end of adductor brevis was cut off and sutured with tensor fasciae latae through the tunnel under the skin, the end of gracilis was cut off and transplanted to the lateral condylus of femur through the back of the knee. Some certain surgery completed at the same time, the semitendious and biceops muscle was transplanted to the front of the knee(37 cases) and extended(13 cases), the soft tissue was released in hip joint(55 cases), the gastrocnemius cut off (32 cases), the Achilles's tendon extended(30 cases) and tibialis anterior lateral transplantation (31 cases), only peroneus longus lateral transplantation (8 cases). After operation the lower limbs was fixed with plaster cast for 6 weeks, then the plaster cast was removedassociating with functional exercise. The orthopaedic results were evaluated on the function of hip, knee, foot-malleoious and the gait, then classified four grades. Results All patients were followed up an average of 24.4 months. The scissors gait was corrected completely, 61 cases were excellent, 10 cases were good, 2 cases were fair. The majority symptom of whem was the knee flexure, but can be relieved by medicine. There were significant differences compared pre-operation with post-operation in four groups, and also between degree Ⅳ group and degree Ⅰand Ⅱgroup(P