Article

Between November 2001 and January 2008, 56 patients (68 hands) out of 110
patients operated for spastic hand deformities, presented with spasticity of the
intrinsic muscles of the long fingers (interosseii and the abductor pollicis brevis).
All patients were adults
(mean age 42.1 years).
The surgical indication
was discussed during multidisciplinary consultations with selective nerve blocks
enabling us to distinguish between extrinsic and intrinsic pathologies on the one
hand and muscular spasticity and tendon retractions on the other hand. The aim of
the treatment was defined in a "contract" signed with the patient and/or his
family. It was hygienic, aesthetic and analgesic in 15 cases, hygienic and
analgesic in 32 cases and functional in 21 cases. Four hands were treated by
neurectomy of the ulnar nerve's motor ramus, 54 by tenotomies of the interosseous
muscles, 18 by tenotomy of the abductor digiti minimi, six by metacarpal
disinsertion of the interosseous muscles. On a total of 67 hands operated
associating surgery of the extrinsic and intrinsic flexors, 63 had good primary
results as defined in the contract. We noted four relapses, two of which required
revision. The authors emphasize the frequency of mixed spastic hands in adults
after cerebral palsy. However modest the functional results may be, correction of
hygienic and pain problems of non-functional hands as well as aesthetic
improvements make surgery of the mixed spastic hand a successful intervention,
which should be shared.
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Langue : FRANCAIS