The treatment of patients with the musculoskeletal system pathologies
The basis of the method
In our medical center we use phased (step-by-step) fibrotomia (PFT) as the main method of treatment for people with musculoskeletal system disorders. This surgical technique is a unique one. It was invented and put to use by F.D. Professor V.B. Ulzibat. The method basis is the elimination of local muscular contractures (scars) and pain syndrome (Patent Russian Federation №1621901 with the priority from 24.09.87).
The muscle cicatricotomy is the essence of this method. It is performed with the help of the special scalpel (Patent Russian Federation №1560143), which enables the surgeon not to make large skin incisions.
The advantages of phased fibrotomia (PFT) in comparison with the other surgical methods of treatment on skeletal muscles are:
- The low possibility of injury. The operation is fulfilled in a spare way locally in the scar zone. There are no skin incisions. The healthy muscles remain safe because there is no total transaction. There is no need of plastering because there is no work on tendons and bones. The postoperational wounds are easy to take care of.
- Method versatility. It is possible to operate on any superficial skeleton muscle: on your head, neck, body, limbs. It enables us to influence on different muscle groups at a time.
- Effective time. The patient is operated in “a surgical day hospital”. Usually the health recovery goes quicker at home.
- Minimum of contra-indications. There are no contra-indications connected with the early age of patients; with hyperkinetic, convulsive, hydrocephalic, asthenic syndromes; with mental and physical retardation, with compensated chronic diseases and congenital anomalies (hydrocephalus, heart disease, stridor and others).
This method can be used for the treatment of various musculoskeletal disorders because upon different influences similar changes appear in the muscular tissue (injury, infection, allergens, toxins and so on).
The treatment has several phases. In each phase we debride from 10 to 16 muscular contractures at a time with general or local anesthesia. For one phase there are from 4 to 6 PFT. On each stage we come to agreement with a patient or his representative (a parent) about the operation plan and paper work.
The time of the next operation depends upon the movement disorders complexity, on the presence of associated illnesses and on the growth rate (for children).
The removal of muscular contractures and pain syndrome enables to increase substantially the range of motions. It helps to receive new motion skills and to improve the existing ones. The increase of the overall motion activity stimulates mental development, broadens the range of interests, betters self-service skills. In difficult cases it makes the nursing considerably easier.
The surgical treatment effectiveness and the techniques uniqueness attract people from various towns in Russia and from different countries abroad (Ukraine, Azerbaijan, Estonia, Latvia, Spain, Greece, Serbia, Montenegro, Croatia, Bosnia and Herzegovina, Italy, Poland, Germany, Sweden, USA, Israel, India, Argentina, Australia).
For 16,5 years 29 839 patients (data on 31.12.08) have been received for the treatment, including 23 572 children (79%).
At the average we operate 3500 patients annually. 90% of all the clients are the children suffering from ICP. Among all the operated 75,2% are the people with spastic tetraparesis and with spastic diplegia. 94% of patients have mean and advanced degrees of motion disorders.
The afterhistory analysis made by independent medical experts from different cities of Russia and by the institute staff shows that we can see the constant improvement in the general clinical performance. The increased range of motions, the onset of new movement skills and the improvement of existing ones were considered to be the cure rate. In the definite period of treatment 10 – 18% of patients had no substantial changes, 1 – 3% suffered from pain on the muscle zones which hadn’t been operated on before. This medical phenomenon was considered to be the deterioration. The changes connected with pain were temporary and were eliminated on the following stages of treatment. In accordance with pain and muscle contracture localization the effectiveness of phased fibrotomia was 96,3-97,7%.
Furthermore we notice supplementary positive effects such as: the improvement of speech, mastication, swallowing, emotional and behavioral indexes, memory, attention, sleep, appetite, the decrease of strabismus, nystagmus and salivation, the improvement of visual and hearing acuity, the normalization of urination and defecation.
Having observed the patients during 16,5 years, we can confirm that the optimum time for the operation is the stage of the early muscle contractures onset before the occurrence of persistent contractures and joints deformations. In this connection it’s highly advisable if you wish to get positive permanent results quickly with minimum number of operations, you should begin the surgical treatment in the early age (from 3 to 5 years).