there are several types of operations Mechanical: - on bone: osteotomy. Example: Cutting a slice of the femur to reorient the femoral head. - tendons on tendon elongation greenfield: the surgeon lengthens the tendon. The segment is locked six weeks in plaster and splints time to rebuild tissue. The downtime is very painful and can cause regressions. This intervention is used when the amplitude function is lost. It removes the muscular efficiency as the ratio muscle (motor) tendon is changed because the tendon is longer. - avulsion of the muscle: it detaches muscle from the bone and he hangs up only a little lower this action removes the muscular efficiency since, now formerly polyarticular muscle does not cross over a joint (Example: the twins naturally secured to the femur, no longer cross the knee in the back and are lining on hulls condylar) - tendon transplantation: example: we divide the lower insertion of tibialis anterior and it secures the outer part of the cuboid . Thus the action "reliever" tibialis anterior is in the axis of the foot. There is a neurological intervention: but it does not control, it destroys the time neuro muscular muscle to decrease the action of spasticity. There will again decline in muscle performance.
1 st example, the surgeon told me that I walk "normally". Two girls diplegic (autonomous walking in town, 5 km / h) with one pole and one without a cane, I tell the same story. In both "want" to each his surgeon (two different surgeons) that they have "lied". Presumably, when the surgeon said "you walk normally," he spoke of walking functional de l'autonomie en ville qui est acquise pour les deux dans le périmètre et dans la vitesse. Mais ce que les deux avaient "entendu" c'est ce qu'elles traduisaient par "normalement": je ne vais plus boiter or je marche toujours comme une diplégique en raclant le sol avec la pointe de pieds. L'une des deux cherchait même un chirurgien (qu'elle aurait fini par trouver) pour reprendre l'opération. Il a fallu que je lui écrive "aucun chirurgien au monde ne peut te rendre les neurones des releveurs de pieds qui ne fonctionnent pas. Aucune opération au monde n'est capable de te permettre de relever activement le pied lors du temps pendulaire. Tant qu'on ne saura pas faire pousser les neurones des releveurs de pieds, you walk like a diplegic but your work is aesthetic and functional.
2nd example: dilemma: to walk deformed feet. M has diparésie . Parents of M: it Do not do too much walking M if his feet hurt locked due to paresis) will deform. the physio : there is a choice between: - do not learn to walk in M not to deform his feet. But his feet will collapse as they adapt to the non-walking. - M or learn to walk and therefore accept that the legs fit for walking ("feet flats ") as there are not enough to lock the muscles innervated tarsal and metatarsals.
3rd example: preventive intervention: The deformation is not there, but "If we do not operate now, later it will be worse." 1) the worst is never sure. 2) Pending the worst, there is monitoring for growth and learning self posture . In physical therapy, negative pledges are easier to hold. Let's wait until the defect decreases the function to intervene.
Conclusion: should be measured indications of an operation. An operation is taking a risk, it must be followed by a gain of function or gain of rehabilitation. Too many children BMI lose the ability to run because of an intervention to improve aesthetics ( fantasized ) procedures. The surgeon is happy because the child "works better" and forget that before he could play football with his buddies. In a balance sheet, there is the "observed, measured and reported" .- E. Viel diagnosis physiotherapy - Masson- physiotherapists are very committed to the "measured" (length of a balance, walking speed to the perimeter), attention, some surgeons are more attached to the "observed" and "reported" (more subjective)
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