Método Ulzibat del Doctor Igor Nazarov. Tratamiento de la parálisis cerebral.

Pathological fibres can form on the soft tissue of any part of the locomotor apparatus (on the upper extremities, lower extremities, on the body, on the neck and even on the face muscles).

For example, when it is located on the soleus muscle or on the calf, a pathological fibre causes equinus (talipes equinus). When a pathological fibre is located on the plantar aponeurosis, it causes foot deformities such as varus foot, pes valgus or excavation, among others. Moreover, pathological fibres have a low level of vitality, and they cannot either grow or stretch at the same time as a child’s skeleton.

Growth of the affected extremity is limited, and if contractures are very serious, dysplasia, dislocations and deformities appear. In parallel, during a child’s growth, joint contractures can form as a result of movement limitation (generally from 13 to 15 years of age). In order to try and eliminate contractures of soft tissue in patients with cerebral palsy, different surgical methods are currently being used, beginning with tenotomies and ending with very complicated reconstructive operations on the bone-muscle apparatus. The results of these operations are not always effective, given the following:

- They are fairly invasive.
- Operations are not performed on all the existing contractures. For example, on the lower extremities, operations are performed on only the abductors and the Achilles tendons.
- The immobilisation that takes place after these operations further weakens the musculature and other structures of the locomotor apparatus, which are already suffering from weakness.
- Sometimes after open operations, there are considerable scars that do not have the capacity to adapt to the subsequent growth of the operated area on a child, and they also make it difficult to repeat the surgical method used in the event of a relapse.

Treatment consists of performing subcutaneous operations (closed), which are performed with a fine scalpel (i.e., a tenetome), thereby only sectioning the pathological fibres that limit movement. When the pathological fibre is sectioned in a soft tissue structure, it has no other fastening point, and it can no longer prevent the stretching and correct function of this structure. It is thus possible to eliminate all the pathological fibres that may exist in the entire area of the soft tissue, thereby saving the healthy structures and without using postoperative immobilisation.