extensor hallucis tendon transfer

Treatment of diseases: high arch Indication 1. It can be used as an orthopedic surgery of the big toe claw toe, that is, the interphalangeal joint flexion, the metatarsophalangeal joint overextension, and the humeral head plantar flexion [Fig. 1]. In the case of the toe-toe-toe-shaped toe, the toe end, the toe back and the forefoot base may be affected by the pressure, which may affect the walking and standing. The extension of the long thumb tendon and the interphalangeal joint may be used to correct the deformity. 2. Can be used as an auxiliary surgery to correct high arch foot. High arch foot, also known as emptied foot, claw foot, has three characteristics: (1) forefoot flexion combined with high bow; (2) may have heel enlargement; (3) upper toe Or claw shape. The high arch foot is mostly caused by the weakening of the dorsal extension of the foot and the interosseous muscle and sacral tendon. This type of malformation is more common in children over the age of 3 and increases with age. Although the deformity of the foot is not too serious, it can seriously affect the function of the diseased foot. Therefore, in the case of non-surgical treatment, the deformity is still developing, and the muscle strength should be balanced in early surgery to prevent the development of deformity. The extension of the longissimus dorsi tendon can be used as an auxiliary orthopedic surgery. In addition to correcting the upper toe or claw shape of the thumb, it also has a certain effect on enhancing the extension of the foot and correcting the forefoot flexion and high bow. 3. It can be used as an auxiliary surgery to enhance the balance of the back of the foot and adjust the balance of the muscles. For example, the flexor tendon caused by the iliac tendon can transfer the anterior tibial tendon to the tibia and transfer the long tendon of the thumb to the first. 1 ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; In this way, the back extension of the foot can be enhanced, and on the other hand, the balance of the internal and external rotation forces can be maintained to prevent secondary deformity. Preoperative preparation After a group or a muscle is paralyzed, the balance of muscle strength is imbalanced, which will inevitably cause deformity and a series of functional and structural changes after malformation. Therefore, detailed examination, careful analysis, and necessary preparations are required before surgery: 1. The number and degree of muscle spasm vary, due to the length of the date, the influence of gravity, the amount of use and the weight of the deformed foot can cause different deformities. Almost every patient's deformity has its own particularity, and even the same muscle tendon can often cause different deformities. Therefore, it is necessary to conduct a detailed examination and thorough understanding of the deformity, muscle spasm, and muscle strength of the abscess before surgery, and fully estimate whether a new imbalance will occur after the transfer, and a new malformation will occur. In this way, the surgical design can be tailored to the patient's specific situation and the expected results are achieved. Otherwise, it is very likely that the original deformity has not been corrected, but instead caused another deformity. 2. All soft tissue contracture deformities and deformities of the bone structure must be corrected before the metastasis, or corrected before surgery. It is not in principle and impossible to correct these deformities by relying on muscle strength after tendon transfer. Only after the deformity is corrected can the transferred muscle maintain the corrected condition and prevent the recurrence of the deformity. 3. After the muscle is paralyzed, the balance of muscle strength is imbalanced, and the limb function is affected to some extent, so that the muscles of the attempted atrophy will also shrink to varying degrees, the muscle strength will be correspondingly weakened, and the joint activity will be limited. Therefore, exercise should be strengthened before surgery, supplemented by physical therapy, etc., so that the function can be restored as much as possible, and the muscle strength reaches 4 to 5 to ensure the effect of surgery. 4. Prepare a sufficient range of skin as usual on the 2nd day before surgery. After the deformity of the foot, it often occurs in the weight-bearing part. Before the operation, it is necessary to soak the feet with warm water to make the skin soft and clean, in order to facilitate surgery. Surgical procedure 1. Position: supine position, high limbs. 2. Incision: There are two incisions: a short l-shaped incision on the lateral side of the interphalangeal joint of the big toe; a short longitudinal incision along the lateral side of the distal part of the first metatarsal. 3. Metastasis of the longissimus dorsi tendon through the toe incision to extend the longissimus dorsi tendon, the tendon is transected at the proximal end of the interphalangeal joint. This tendon should be kept about 1 cm for the interphalangeal joint fixation or suture with the short flexor tendon. The proximal tendon was pulled from the ankle incision and protected with saline gauze. The first perone periosteum was cut longitudinally, the neck was exposed, and a small hole was drilled on both sides of the back side to scrape the bone between the two holes to form an intraosseous tunnel. The proximal end of the longissimus tendon is inserted through the tunnel to form a tendon. When the tendon is pulled in the neutral position of the ankle, the tendon is sutured to the side. 4. The purpose of the interphalangeal joint fusion is to avoid the occurrence of hammer toe. First flexion of the metatarsophalangeal joint, to observe whether it can correct its over-extension; if it can not be corrected, and due to contracture of the dorsal joint capsule, it should be cut open. Then cut the interphalangeal joint capsule, use the small bone to cut the joint surface at both ends of the joint between the toe and the toe, and sew the distal tendon stump of the severed tendon long tendon to the interphalangeal joint capsule, and then hit the end of the toe. Insert a Kirschner wire through the distal and proximal phalanges to fix the function in the medullary cavity. Finally, two incisions were sutured. If the patient is a young child, the interphalangeal joint fusion is not easy to heal, or the claw-toed deformity is lighter. After the extension of the longissimus dorsi tendon can be corrected, the interphalangeal joint fusion can be temporarily disabled; the short flexor tendon attachment point can be cut off. It is sutured to the distal end of the longissimus dorsi tendon, and the short flexor muscle is used instead of the extension of the longissimus dorsi muscle to prevent sagging of the lumbar spine. In the future, if a spasal toe occurs, then the interphalangeal joint fusion is performed.