Orthopaedic treatment of paralysis

Orthopedic treatment of paralysis is to eliminate the deformation of the musculoskeletal system (contractures, restrictions of movement and resultante in the joints), in restoring strength, tone muscles, and also in preventing the strengthening of spastic phenomena for cerebral palsy or progression of weakness of the muscles of flaccid paralysis.
Orthopaedic treatment of paralysis vary depending on the period of illness. In the acute period, it reduces to the prevention of the formation of contractures. With this purpose it is necessary to ensure that limbs patient was in the right (physiological) position (Fig. 1 and 2). With flaccid paralysis use of splint, splint.


Fig. 18. Plaster bandage to fix flexion contractures in the knee: 1 - with hinge and spin; 2 - stage.

In open injuries of peripheral nerves need for prevention of festering wounds, early binding nerves. In the recovery period all treatment activities aimed at restoration of the lost functions (massage, therapeutic exercise, medication, with flaccid paralysis - electrostimulation paralyzed muscles, hot packs"), elimination of contractures by an extension of orthopaedic devices (see), a plaster cast (Fig. 18).
In the period residual effects of polio resort to operations on the bones, joints, muscles (artrolita, artrodeza, tendon-muscular plastic). Is also used orthopedic shoes, orthopedic corrective devices. Correct installation of the patient, splinting extremities (e.g. polio) allow to avoid the development of contractures. Start orthopedic treatment always with conservative measures and only after preparing or no effect over to operations. The purpose of orthopedic apparatus is made with the purpose of treatment and to consolidate the achieved results; the same applies to physical therapy, massage.
Bowel paresis - see bowel Obstruction.

Among the various lesions of the nervous system, accompanied by various disorders of the limbs and spine, it is necessary to distinguish spastic cerebral palsy, as well as sluggish, or peripheral paralysis. The highest percentage of patients requiring orthopedic aid, are children suffering from deformities and function disorders of musculoskeletal system.
Patients with clinical symptoms of spastic cerebral palsy need long-systematic treatment; it must be comprehensive, to combine medical therapy, physiotherapy, occupational therapy, conservative and surgical orthopedic activities, Spa treatment, as well as learning to crawl and walk. Orthopedic treatment in the first months of a child's life is to change the situation and correct laying, to teach the child to keep his head, and to prevent the development of contractures and primary vicious provisions of the limbs. Simultaneously with it it is necessary to conduct therapeutic gymnastics, first, passive, and from 7-8 months active, warm baths. If there contractures often resort to anatomii or myotomies followed by the application of a plaster bandage. To correct contraction in hip and knee joints are used high plaster bandage with thick cotton lining, which after 6 weeks replace large gypsum-gelatin cot (EAST of Jaklin). In such a cot hold a baby in a few months, while employing a warm baths, therapeutic exercise and medical treatment. In spastic paralysis, excluding transactions on the muscles and tendons, apply operations on the nerves and sometimes on the bones. To resolve eqwinus foot position appropriate extension of the Achilles tendon and the operation of Stoffel II, separately and in combination. When flexion contractures of the knee effective anatomii (see) and plastic elongation of flexors of the leg. Surgical intervention in the hip joint region is mainly in the elimination of lead and flexion contractures by subspindle myotomies and myotomies of adductors. To eliminate the causes contraction applied also resection locking nerve (intrapelvic on Selingo or Netesova by A. S. Vishnevskaya). Of particular importance in the consolidation of the results of the treatment is the application of prosthetic and orthopedic devices.
When treating patients with paralytic form of polio is of great importance orthopedic prevention. Treatment should be complex, continuous and continue in some cases for many years. Orthopedic treatment should start from the time of diagnosis and detection of certain paresis and paralysis. Prevention is primarily in creating the correct position of the patient in bed and ensure the full rest in the acute stage of the disease regardless of the age of the patient and forms of polio. The mattress should be firm enough, baby lie on your back with your legs extended, feet should not hang down, and at right angle to rest against a vertical stand. To prevent internal or external rotation limbs her stack between sand bags. Such position of the limbs prevents the development of contractures and prirastajte muscles and ligaments. Young and the restless children to keep the feet in the correct position impose plaster or plastic removable bus to the groin. If you suspect a defeat polio back muscles and body of the patient should be put in plaster cot and hold in position on his stomach. With a sharp pain T. S. Zatsepin and I. M. Presman recommended to put the children on a large, tightly filled pen cushion to create lordosis, which decreases tension of the spinal cord, roots and decrease pain. All activities on the prevention of contractures should be carried out in conjunction with physiotherapy, first, passive, and then as muscle recovery is active.


Treatment in the recovery period polio is to prevent and resolve already developed contractures with the help of massage, medical gymnastics, stretching. Also used tire cigarette-making machines. More surgical intervention used in the period of the residual phenomena with the aim to restore or improve muscle balance, to create a sustainable limb. The right choice of one or the other operations can be done on the basis of a thorough analysis of the picture of paralysis and muscle strength. First of all it is necessary to eliminate the existing contracture, which is achieved by corrective gymnastics, heat treatments, permanent traction goods, orthopedic devices, landmark plaster casts, Tenorio-fasciotomies, osteotomies, resection, metaplasia by R. R. the Vreden. Surgical intervention used in this period are: (1) extension of the tendons and the intersection of the aponeurosis, 2) in tendon transplant functioning of the muscles to replace the function paralyzed, 3) in a stabilizing operations on the bones and joints in the form of fusion (see) and artrolita (see)and in the fixation of the spine, 4) in the operation of extremity lengthening.
Damage to the peripheral nerves may occur after injury or develop as a result of compression of a nerve scars, bone spur and secondary damage it. Traumatic nerve damage and nerve plexus is possible at any age (see Plexitis). Treatment should start as early as possible. To do this systematically conduct massage and physical therapy, use vitamins B1 and B12. When you open the damage of soft tissues and promptly recognized nerve damage, be aware that peripheral nerve trunks have a high regenerative properties, for the manifestation of which is necessary to create the appropriate conditions. The main conditions for axonal sprouting from the Central section of the peripheral nerve in are: prevention of wound infection and correct mapping of the edges of the damaged nerve trunk. The sooner this is done, the more prerequisites for a positive outcome. For uncomplicated wound best time for an operation are the first two weeks.
When applying primary closure nerve necessary to preserve the integrity of epineurial, and allocated the nerve to put in the bed unchanged muscles or to embrace it fibrin film. Later, when you cannot impose primary closure, limited neuroliteb, neurologia, substitution paralyzed nerve and large defects, plastic nerve, as well as operations on the tendons and joints (Fig).
The most frequent object of neurolite are radial, ulnar, the median nerve, peroneal nerve. Plastic nerve make in those cases when the nerve defect is so great that produce Euroradio not possible. Best replacement material is frozen gomotransplantatov.
With persistent changes and in case of failure restore nerve function resort to operations on the bones, joints, muscles. If the damage is the major peripheral nerves of the lower extremities - femoral and tibial and in the presence of persistent disorders are applied in some cases artrolita, in other artrodeza Golino-ankle joint. Artrodeza method R. R. Vreden and A. A. Oppel, Yu. Yu. Dzhanelidze, Mortuary are made with pronounced side resultante foot. When protruding foot can be limited to the rear arthrorisis on Campbell or C. D. Chalino. Isolated damage peroneal nerve resort to transplant tibial tendon muscles on the outside edge of the foot - in cases of damage of a superficial branch, and to transplant tendon long peroneal the muscles on the inside edge of the foot - if the damage is deep branches of the nerve. When damage to the sciatic nerve because sooner coming trophic disorders (trophic ulcers) have to be amputated, or to provide patients with orthopedic shoes. In more rare cases are made orthopedic stabilizing operations.
On the top limb paralysis of the radial nerve, producing various kinds of transplantation flexor on the extensor brush. The most effective are the operations E. Yu Osten-Saken, Yu. Yu. Dzhanelidze, in which the tendons in the elbow flexor brush moved on long extensor and long lateral muscles of the thumb, and tendons of the radial flexor on the common extensor fingers.
The experience of many national surgeons Yu Yu Dzhanelidze, N. N. Dei priori, M. C. Strukov, V. D. Chaklin and others) has shown that this operation ensures the active extension of the fingers.

Orthopaedic treatment of paralysis: 1 - allocation of tendons of the common extensor fingers, and tendons long extensor and long lateral muscles of the thumb (top left is a skin incision); 2 - selected tendon ulnar and radial flexor brushes for transplantation on the back of the hand (at the bottom left - skin incision); 3 - "cross" transplantation; elbow tendon flexor on the back surface of the forearm is held under the tendons of the common extensor fingers and sewn to the loop formed sinew, going to the big finger (long extensor and long lateral muscles of the thumb), tendon radial flexor sewn to the loop formed sinew of the common extensor fingers.