Complete release of the iliac wing muscles and transposition of the iliac crest

Surgical treatment of sequelae of polio is performed by sacral pterygoid muscle lysis and tendon transposition. The sequelae of polio, also known as poliomyelitis sequelae, refers to a disease in which children's dyskinesia and deformity are caused by poliomyelitis caused by poliovirus. Polio is a viral infection confined to the motor cells of the anterior horn of the spinal cord and certain brainstem motor nuclei. Usually caused by one of three polioviruses. The virus initially invades the digestive tract and the respiratory tract and is subsequently disseminated to the central nervous system via a blood-borne pathway. The incidence of acute spinal anterior polio has been significantly reduced since the polio vaccine was developed and widely used. The disease currently occurs mainly in children under 5 years of age in tropical and subtropical developing countries and in non-immune populations in other mild climates. In the past 10 years, there have been morbid polio in North America and Europe. The poliovirus invades the body through the oropharynx, proliferates in the digestive tract lymph nodes, and then spreads through the blood, impairing the motor cells of the anterior horn of the spinal cord, especially the lumbar enlargement and neck enlargement. The incubation period is 6 to 20 days. The motor cells of the anterior horn of the spinal cord can be directly damaged by virus proliferation or its toxic products, and can also be indirectly damaged by ischemia, edema and peripheral bleeding. The intramedullary destruction was focal, and there was a significant Wallerian degeneration in the full length of each nerve fiber within 3 days. Macrophages and neutrophils surround and remove some necrotic ganglion cells, and the inflammatory response gradually subsides. After 4 months, the area in which the anterior horn motor cells have been destroyed is filled with compensatory proliferation of glial cells and lymphocytes. The number of muscle masses affected and the severity of paralysis are variable; the degree of clinical muscle weakness is directly proportional to the number of motor units lost. When more than 60% of the nerve cells that innervate the muscle are damaged, the muscle weakness can be detected clinically. The muscles innervated by the cervical and lumbar segments of the spinal cord are most susceptible, and the frequency of paralysis of the lower limbs is twice as high as that of the upper limbs. The most susceptible muscles in the lower extremities are the quadriceps, gluteal muscles, tibialis anterior muscles, medial hamstrings, and hip flexors. The potential for muscle function recovery depends on the recovery of reversible anterior horn cells. The initial recovery occurred in the first month after acute onset, and most of the sick children completed recovery within 6 months. The course of polio can be divided into three phases: acute phase, recovery phase, and chronic phase. The acute phase usually lasts for 7 to 10 days. Systemic symptoms may include fatigue, sore throat, and mild increase in body temperature. There may be limb hypersensitivity or paresthesia, severe headache, sore throat, vomiting, neck stiffness, back pain, and straight leg elevation. Restricted, etc., eventually asymmetrical paralysis. In older children, mild warming, marked flushing, anxiety, and muscle aches can occur, and tender palpation can also induce tenderness. Usually shallow reflections disappear first, and deep tendon reflexes disappear when the muscles are paralyzed. The recovery period begins when the body temperature returns to normal and begins to two years. Muscle strength improved spontaneously during the first 4 months and was slower thereafter. Johnson believes that the muscle strength of a muscle is still less than 30% of normal after 3 to 4 months, it should be considered permanent paralysis. Muscles with more than 80% muscle strength can recover without special treatment. The chronic phase begins 24 months after the onset of acute disease, which manifests as significant muscle imbalance and soft tissue or bony deformity. Because the foot and the ankle are the most dependent parts of the body on the surrounding structure and other factors, and subject to a large amount of stress, they are easily deformed due to muscle paralysis. The most common ankle deformities include: claw toe, varus deformity of the foot, dorsal bursitis, clubfoot, clubfoot, high bow varus, clubfoot, and foot. The treatment of sequelae of polio is aimed at correcting muscle imbalance. When the deformity caused by dynamic muscle imbalance affects walking or limb function, it is feasible to perform tendon transposition. Arthrodesis is a joint that stabilizes relaxation or flail by partially or completely limiting the range of motion of the joint or eliminating abnormal activity. Arthrodesis should be delayed until 10 to 12 years of age to achieve adequate development. Treating diseases: polio sequelae polio Indication The iliac crest muscle complete lysis and tendon transposition are suitable for paralytic hip flexion abduction external rotation contracture deformity. Preoperative preparation Regular preoperative examination. Surgical procedure Campbell method: 1. Make a skin incision along the anterior iliac crest 1/2 or 2/3 to the anterior superior iliac spine, and then extend 5 to 10 cm distally in front of the thigh. Cut the shallow deep fascia attached to the tendon. The starting point of the tensor fascia, gluteus medius and gluteus medius was exfoliated from the humerus to the subperiosteal, down to the acetabulum (Fig. 12.39.8.2.1-4). Open the fascia lata muscle and the proximal part of the sartorius muscle. Use the osteotome to cut the anterior superior iliac spine together with the starting point of the sartorius muscle, and pull the two toward the distal end. The front edge of the tibia is exposed to the anterior inferior iliac spine. The abdominal muscles were peeled off from the subperiosteal (or the muscles were attached and cut into a narrow strip); the diaphragm was removed under the periosteum of the humerus. The rectus femoris is straightened from the anterior lower iliac spine, and the inverted head is released from the acetabular leading edge. After loosening these contracture tissues, the hip joint can often reach over-extension without increasing lumbar lordosis; this is the most important point, because the correction of the deformity may appear to be much more obvious than the actual situation. If the hip joint cannot be overstretched, the other contracture tissue must be severed. If necessary, the hip joint capsule can be incised obliquely from the proximal end to the distal end, and the iliopsoas muscle is cut from the small trochanter, which is the last resort. 2. After the deformity is completely corrected, the exfoliated humerus is partially removed with a bone knife (Fig. 12.39.8.2.1-5). The abdominal muscles were then sutured to the edges of the gluteal muscles and tensor fascia latas with intermittent sutures on the remaining humeral surface. The superficial fascia on the medial edge of the incision was sutured to the deep fascia on the lateral edge of the incision, and the skin incision was moved to the posterior side of the humeral margin 3. In order to protect the humeral epiphysis of young children, the surgery can be improved as follows. Free muscles under the periosteum from the lateral aspect of the tibia. The sartorius muscle and the rectus femoris muscle are peeled off as described above, and the joint capsule and the iliopsoas muscle can be released if necessary. It is not necessary to peel the muscle from the medial side of the tibia. Next, a wedge-shaped bone is drilled from the iliac crest on the distal end of the epiphysis from the front to the back with a bone knife; the wedge-shaped tip should be located as far as possible behind the end of the incision, and the wedge-shaped base is oriented forward, with a width of 2.5 cm or more, so that it must be corrected The deformity is correct. Then, push the ankle to the distal end and close it to the humeral body, and fix it by suturing the soft tissue.

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