tendon transfer

When a group or a muscle is weakened or lost due to various reasons, the tendon of the adjacent healthy muscle can be transferred to a suitable site, and the balance of the imbalanced muscle strength can be restored to a better balance to improve function and prevent deformity. Occurs, this is the tendon transfer surgery. Clinically used for the treatment of sequelae of poliomyelitis. The purpose of the operation is: 1. Replace the muscles of the sputum, restore the limb function. When a small number of muscles occur in a simple muscle, the tendon metastasis can replace its function and restore the limb function. Such as quadriceps tendon, you can use the biceps femoris, semitendinosus tendon as a substitute for metastasis. 2. Adjust muscle strength balance to prevent malformation from occurring in patients under 12 years old, some muscles have not been deformed after sputum, or although deformity has occurred, but it is not a fixed deformity, can be corrected by soft tissue surgery, tendon transfer can Adjust muscle balance, improve function, and prevent the occurrence or development of deformity; after joint fusion or other permanent stabilization surgery, bone resection can be reduced, orthopedics are easy to perfect, and the curative effect can be guaranteed. 3. Assist in orthopedic surgery to prevent deformity of the deformity. Partial muscle spasm has occurred. Bone deformity has occurred. In patients over 12 years old, bone orthopedic surgery should be performed with tendon transfer to improve muscle balance and prevent recurrence of deformity. . Treatment of diseases: peripheral sequelae of polio sequelae Indication 1. Acute poliomyelitis sequelae After 2 years of non-surgical treatment, the muscle function of the sputum is not restored, and those with conditions can perform tendon transfer. 2. Peripheral nerve injury causes a group or a muscle spasm, affecting limb function or progressive malformation, peripheral nerve injury can not be repaired or repaired after invalid, feasible tendon transfer surgery. 3. The tendon defect caused by trauma can not be repaired and affects limb function. 4. A small number of sputum sputum severely affect the function, muscle tendon transfer can be used to adjust muscle balance to improve function. Contraindications 1. The transferred muscles must be sound and have sufficient muscle strength to take on the new functions after transfer. The length of the tendon should be sufficient to shift to the expected new stop. After the muscles are transferred, the muscle strength must be weakened. Therefore, when using similarly functioning muscle metastases (such as tibialis anterior tendon with longus muscle metastasis), the muscle strength should be at least 4 levels; if the opposite function of the opposite muscle transfer, the muscle strength must be normal. It will be disadvantageous to transfer the muscles with insufficient muscle strength. 2. Whether the effect of tendon transfer can be satisfied, the muscle strength of the tendon should be transferred, and the active functional training after transfer. Muscle strength examination and functional training require patient cooperation and active coordination, otherwise it will affect the effect of surgery. Therefore, surgery should be performed when the sick child can work well together (usually at least 5 years old). 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: A total of 4 incisions are required: Incision 1: slit in the inner side of the first clavicle and the scaphoid, about 2 cm long; Incision 2: longitudinally cut at 2 cm on the posterior border of the medial malleolus, about 4 cm long; Incision 3: 3 cm on the anterior aspect of the medial malleolus, longitudinal medial section of the tibialis anterior tendon, about 5 cm long; Incision 4: longitudinally cut above the second cuneiform bone of the foot, about 3 cm long. 3. Separation of the posterior tibial tendon: The posterior tibial muscle stop is revealed from the incision 1 and cut off, and the length should be retained as much as possible. The posterior tibial tendon is separated at the incision 2 and the muscle is withdrawn from the incision 2. 4. Reveal the incision of the interosseous membrane: the tibialis anterior muscle is revealed at the incision 3. The muscle and its lateral anterior tibiofibular vein, deep peroneal nerve and elongate tendon are pulled to the outside to expose the interosseous membrane, and the interosseous membrane is longitudinally cut into a small opening. When making this interosseous incision, be careful not to cut too deep to avoid damage to the posterior tibial and posterior iliac vessels. Be careful not to damage the periosteum of the tibia to avoid ossification in the future and affect the passage. 5. Transfer the tendon: use the long curved hemostat to extend from the incision 3, through the interosseous incision, the posterior aspect of the humerus is worn back to the incision 2, and the end of the tendon is clamped to the incision 3, and the anterior and posterior incisions are observed. Tendons are accessible through barriers. If the fibers pass through other muscles, they should be re-passed; if the interosseous incision is too small, it should be enlarged or a transverse incision should be added at both ends to make the tendon open in a straight line. A subcutaneous tunnel is made from the incision 3 to the incision 4, and the tendon is withdrawn. 6. Fixing the tendon: Open the incision 4, reveal the 2nd cuneiform bone, cut and peel the periosteum, expose the bone, and drill vertically with a bone drill to make a short intraosseous tunnel. The soft stainless steel wire was used, and the broken end of the tendon of the tendon was sutured by stainless steel wire, and the end of the tendon was pulled into the tunnel. The steel wire was worn out of the plantar skin and fixed by a button, and the extracted steel wire was taken out from the upper corner of the incision 4. Finally, each incision is sutured separately. complication Tendons.