Avaliação crítica das técnicas cirúrgicas de correção do equino.

Abstract

RESUMO A deformidade em equino leva a diversos transtornos da marcha, ao causar alterações no apoio do pé e afetar regiões anatômicas mais distantes, como o joelho, quadril e tronco. Geralmente é secundária à retração, encurtamento ou espasticidade do tríceps sural, de modo que algumas intervenções cirúrgicas podem ser necessárias para corrigi-la. Trata-se de um dos procedimentos mais antigos da Ortopedia, antes realizado apenas no tendão calcâneo e que, ao longo do tempo, evoluiu com técnicas diferentes de acordo com o grau de deformidade, doença de base e perfil do paciente. Busca-se corrigir a deformidade, com a menor interferência possível na força muscular e, com isso, diminuir a incidência de complicações, como marcha agachada, arrastada e pé calcâneo. Do ponto de vista anatômico, o tríceps sural apresenta cinco regiões que podem ser abordadas cirurgicamente para correção do equino. Em virtude da complexidade do paciente com equino, os ortopedistas devem ter experiência com ao menos uma técnica em cada zona. Neste texto são abordadas e analisadas criticamente as técnicas mais importantes para correção do equino, principalmente de modo a evitar complicações. Foi realizada uma busca sobre técnicas cirúrgicas mais comuns de correção do equino em livros clássicos e identificação e consulta aos artigos originais. Em seguida, fez-se uma busca em bases de dados nos últimos dez anos.

Relation of the Sural Nerve and Medial Neurovascular Bundle With the Achilles Tendon in Children With Cerebral Palsy Treated by Percutaneous Achilles Tendon Lengthening

“…1,2 It can be done by open or closed/percutaneous methods. 2,11 The percutaneous technique using 3 hemisections 10 has advantages of minimal scarring, immediate weight bearing, shorter operation time, less immobilization, and less pain. 1,4,5,12 The first incision was recommended to be 1 cm proximal to the Achilles insertion and the distance between hemisections were suggested to be 1 inch or 2 to 3 cm in most of the articles on adults.…”

“…PAL was performed with reference to detailed description by Hatt and Lamphier. 2,10 The technique involved 3 separate hemisections of the tendon percutaneously (Fig. 1).…”

“…One of the most common treatment options for toe walking because of a short Achilles tendon (AT) has been the percutaneous Achilles lengthening (PAL), using 3 hemisections. [1][2][3][4] Because of proximity of neurovascular structures around the AT, iatrogenic injury have been a concern about this technique. 5 The sural nerve (SN) on the lateral side of the tendon was shown to be closer to the tendon as it extends proximally.…”

Retrospective case series of inverted V-shape tenotomy of gastrocnemius and recession of soleus at the musculotendinous junction for the treatment of fixed equinus deformity in children with cerebral palsy

“…Volpon and Natale3 advised that orthopaedic surgeons should be experienced with at least one procedure at each region of the triceps surae for equinus correction. DeHeer4 recommended that Baumann gastrocnemius recession offers the best surgical treatment of equinus based on deformity correction without weakness.…”

Η Αποτελεσματικότητα Ενός Συνδυασμένου Προγράμματος Λειτουργικής Φυσικοθεραπείας Και Ελάχιστης Επεμβατικής Ορθοπαιδικής Χειρουργικής Στην Αδρή Κινητική Λειτουργία Παιδιών Με Εγκεφαλική Παράλυση

“…Ως εκ τούτου, ανάλογα με τα ανατομικά και μορφολογικά κριτήρια του μυός [393,414], διακρίνονται τέσσερα βασικά είδη χειρουργικών επιμηκύνσεων της μυοτενόντιας μονάδας: (1) η εξωμυϊκή τενόντια επιμήκυνση ή περιφερική τενοντοτομή, δηλ. διατομή του τένοντα εκτός της μυϊκής γαστέρας μέσα από ποικίλες μεθόδους, όπως (α) απλή επιμήκυνση-πλήρης τενοντοτομή (π.χ., σε ημιτενοντώδη [415], τεχνικές επιμήκυνσης γαστροκνημίου κατά Vulpius ή Baker [411,[416][417][418]), (β) επιμήκυνση τύπου Z (π.χ., σε ημιτενοντώδη, ισχνό προσαγωγό [323,419], Αχίλλειο τένοντα [411,416]) και (γ) ημιτενοντοτομές (π.χ., [411,416,420]× (2) η ενδομυϊκή τενοντοτομή, δηλ. διατομή του τένοντα εντός της μυϊκής γαστέρας (π.χ., σε ημιτενοντώδη [413,419],…”