1. Surgical Intervention for Sequela of the Lower Extremities following Poliomyelitis
振興醫院 骨科部 熊永萬 敖曼冠
Introduction:
Paralytic poliomyelitis is almost extinct in the world . While immunization has markedly decreased the incidence. it has no effect on those who already have had the disease. Residual poliomyelitis is still occasionally seen in the adult & elderly.
The long-term consequence of paralysis from poliomyelitis is deformity, the location and type depending on the muscles affected and imbalance between muscle groups. With skeletal growth, leg shortening, soft tissue contractures and foot deformities often develop in poliomyelitis. Treatment strategies require consideration of several factors, including the instability from muscle imbalance, the presence of knee and hip contractures or poor soft tissue conditions from previous surgery. The goal of orthopaedic surgical treatment is to obtain a painless plantigrade and stable lower limb. Conventional operative techniques include corrective osteotomies, arthrodeses, extensive release of contractures and tendon transfers.
Materials and Methods:
We retrospectively reviewed patients with previous poliomyelitis. The typical contractures of post-polio residual paralysis included flexion contracture of knee, genu-valgum, genu-recurvatum( back knee ), tibia torsion, talipes equinus, clawing toes, flail knee or ankle. Stages of surgical procedures had been done that included soft tissue release or tendon transfer. Some cases combined bony procedures to correct rigid joint deformity

5. Results: Discussion: Conclusion:
All patients with paralytic poliomyelitis had been followed up at least one year after operation. A series of physical course was arranged for the patient postoperatively. These patients had remarkable improvement in their ability for daily activity.
Discussion:
Deformities of the lower extremities following poliomyelitis are liable to occur due to imbalance of muscle power and poor posture. There is also disuse atrophy of muscles and shortening of the leg due to interference with growth. In neglected cases, gross fixed deformities of the hip, knee, and foot occur with severe wasting of muscles. The option of surgical procedures of paralytic poliomyelitis of the lower extremities includes soft tissue release and balance procedures. Some cases need combined bony procedures to correct joint rigid deformities. Dynamic balance with function improved of the lower extremity is the goal of surgery. Pain relief with comfortable brace fitting is fundament basic requirement of the surgical treatment for these victims.
Conclusion:
The decisions in the surgical treatment of paralytic poliomyelitis are more difficult than the procedures themselves. The high incidence of severe joint deformity and loss of function has important implications for the management of these patients. Careful monitoring is needed, and measures should be taken to prevent and retard the progression of degenerative joint disease, including early use and more frequent reassessment of orthoses and calipers, early realignment surgery with osteotomies, and encouragement to avoid the development of obesity.