iliopsoas release and elongation

The iliopsoas muscle release prolongation is used for the correction of hip flexion deformity. In patients with cerebral palsy, hip flexion contracture deformity is more common, mostly accompanied by adduction or internal rotation deformity, mainly due to hip flexor contracture, weakened gluteus maximal muscle strength, and incorrect posture is also one of the factors causing deformity. The presence of hip flexion deformity can affect the weight-bearing function of the knee joint. Mainly affect the extension of the knee joint, if the knee joint is in the flexion position for a long time, the soft tissue contracture of the knee may occur, forming a knee flexion deformity. If the knee joint cannot be straightened, the foot will not be flat, and the horseshoe foot deformity will be formed for a long time. This joint deformity is also often caused by tensor fascia lata and tendon contracture. Therefore, if the hip flexion contracture deformity is not corrected, it can develop into knee flexion deformity and clubfoot. At this time, the patient cannot walk upright, often taking a toe walk, thus forming a squat gait. Therefore, the treatment of spastic cerebral palsy should be treated early. It is generally advocated that children under 11 to 12 years of age should undergo soft tissue lysis, neuromuscular branching to relieve sputum prevention and treatment of deformities. For adults, soft tissue release combined with osteotomy or orthopedics is required to achieve better results. Of course, the current surgical indications should be strictly controlled, and the main causes of malformation and the development of deformity and the relationship with other joints should be analyzed in detail. To develop a complete treatment plan, in addition to surgery, it should also be combined with other comprehensive functional rehabilitation methods. Such as intellectual training, language training, daily life function training and the application of physical therapy and orthopedic braces. Roosth started from the cause and thought that the sartorius muscle, the rectus femoris, and the tensor fascia were close to the anterior aspect of the hip. The contracture within 30° to 40° was mainly caused by these muscle spasms and contractures. Therefore, he proposed to extend these muscles. Bleck pointed out that flexion contracture above 45°, iliac crest muscle and adductor muscle contracture are also dominant. Therefore, he proposed that the lumbosacral muscle release prolonged, the adductor muscle and the obturator nerve branch to correct the deformity and relieve the sputum, but in the cerebral palsy patients, if the hip soft tissue deformity is not corrected in time, the bone can be secondary. Physical structure deformity. Such as femoral neck anteversion angle, hip, valgus and hip subluxation. It is currently considered that only mild tendon dissection for mild hip flexion contracture deformity, the sartorius muscle, tensor fasciae and rectus femoris and part of the gluteus medius muscle are peeled off from the iliac crest, and the periosteum is along the humerus outer plate. Push down to reach the goal of release. For severe acetabular contracture, iliac ablation combined with pre-femoral anterior angle osteotomy to simultaneously correct bone structural abnormalities. For patients with hip dislocation, Phelps classifies them into three categories: Category 1 is an epithelial osteotomy for hip valgus, bone grafting, and walking with a stent; Class 2 is an adductor tendon or contracture. The early endocervical muscle cutting was proposed, fixed in the outreach position, and then practiced walking with the stent; the third type was the thin muscle contracture, the middle of the thin muscles of the strand was cut, fixed in the outreach position, and then practiced walking with the stent. Bleck suggested that only soft tissue loosening should be performed when the hip is dislocated, and the adductor tendon and the gracilis muscle should be cut off at the starting point, the obturator nerve anterior branch should be cut off, and the bone traction after surgery can be gradually reset. For the older, he advocated trochanteric osteotomy. For the dislocation of the old hip, soft tissue release, acetabular capping and trochanteric osteotomy, can correct a variety of deformities at the same time, the effect is better. Treatment of diseases: dystonia cerebral palsy, cerebral palsy Indication The iliopsoas muscle release extension technique is suitable for the hips to be in the internal position when walking, and cannot be passively externally rotated. The passive hip extension can only reach 5°. Contraindications Other hip flexors are paralyzed. Surgical procedure Incision Starting from the anterior superior iliac spine, walking inward and downward along the iliopsoas muscle, ending under the small trochanter, 10 to 15 cm long, cutting the skin and subcutaneous tissue. 2. Tendon loosening Free sartorius muscle, tensor fascia lata and rectus femoris, cut it from the point of attachment, blunt separation, pull the sartorius muscle to the medial side, the rectus muscles pull down to the inner side, the fascia lata muscle pull To the outside, the thigh is externally rotated on the posterolateral side of the rectus femoris and the iliopsoas tendon attached to the small trochanter can be seen. The trailing edge is touched by hand, and the tendon is inserted into the vascular clamp to lift the tendon with a knife. The iliac crest muscle is cut from the periosteum, allowed to naturally retract, and then its free end is sutured to the proximal end of the rectus femoris. This will achieve hip relaxation and retain its hip flexion function. The sartorius muscle, the rectus femoris muscle, and the tensor fascia lata are then sutured in the hip extension with the deep fascia. After examining the uncontracted fiber band, the hip joint is straightened. 3. Suture incision Isotonic saline rinses the wound, completely stops bleeding, and sutures the skin and subcutaneous tissue in turn.

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