Paralysis children's cerebral (paralysis infantilis cerebralis; synonym: Littl's illness) — the spastic diplegia at children which is characterized by deformation of extremities, the caused changes in a head or spinal cord. The reasons causing spastic paralyzes can be divided into three main groups: pre-natal (inborn), patrimonial and puerperal (acquired). The inborn reasons are caused by brain malformations, is frequent with the wrong forming of a skull which are caused by pregnancy toxicosis, diseases of mother (tuberculosis, syphilis, a sapropyra, etc.), mechanical and mental injuries of mother, a radial illness etc. Treat the patrimonial reasons the hemorrhage in a brain and its covers arising owing to unsuccessful use of obstetric nippers and receptions. At a fruit with a big head the skull prelum caused by a narrow basin of mother can be observed. Fruit asphyxia in 70 — 80% of cases are complicated by cerebral paralyzes. Premature births can be an origin of cerebral paralyzes.
Fig. 1. Characteristic type of the patient at an illness Littl (diplegichesky option). Carry to the puerperal reasons generally injuries in the first days and even months of life of the child: bruises, concussions, etc. Infectious diseases can often be the cause of a children's cerebral palsy: meningitis, encephalitis, meningoentsefalita. Prevalence of the spastic phenomena and extent of disturbance of mentality of patients depends on extent of damage of a brain and its covers. Mentally retarded make 56% of all patients with spastic paralyzes. Depending on prevalence and localization of pathological process distinguish a monoparesis — damage of one extremity, a hemiparesis — dysfunction of extremities on the one hand, a paraparesis — dysfunction of the lower extremities, triparez — three extremities, tetraparesis (kvadriparez) — four (fig. 1). On disease severity and clinical symptoms of patients with Littl's illness divide into three groups: easy degree, average and heavy. At easy degree of spastic paresis patients move independently, completely service themselves. The intelligence at the majority of them is not broken. At average degree patients can move either by means of crutches, or with assistance. Self-service is complicated. Often disturbance of intelligence, hearing and sight is defined. At heavy degree of spastic paralysis patients cannot move and to service itself. At the majority of them the mentality, the speech, memory, sight, etc. are sharply broken. At having spastic paralysis considerably tendon jerks are raised (but because of a strong muscular spasm are not caused). Contractures of the flexion bringing type are often observed. In the first days after the birth in view of wet brain appoint dehydrational therapy, complex B vitamins, antibiotics. At decrease in mentality of the child if it managed to be revealed in the first weeks after the birth, appoint Cerebrolysinum. Introduction of Dibazolum or Tropacinum improves conductivity of nervous impulses. Carry out physiotherapy exercises, physiotherapeutic procedures (water, mud, thermal, a diathermy, etc.). For elimination of contractures of joints apply corrective plaster bandages without any effort and change 1 — 2 time a month. After elimination of contractures appoint nitrovarnish polyethylene or plaster night tires or beds, and for day stay — orthoses or orthopedic boots with a high rigid back. At the sharp spastic phenomena appoint fixating devices with locks in knee joints, at easy defeats — bezzamkovy. Further the issue of surgical treatment for the purpose of elimination of contractures and transfer of the patient in vertical position is resolved. Operations on peripheral nerves make on the lower extremities more often. The Vnutrytazovy resection of a locking nerve more often on both sides eliminates the most painful bringing contracture and considerably improves gait of the patient. The technique of operation is developed by Selig — Chandler (see Selig — Chandler an intra pelvic resection of a locking nerve). At an extra pelvic resection of a locking nerve (according to Vishnevsky A. S.) most often in combination with a myotenotomy of adductors make a skin section from a pubis on the course of a long adductor up to 10 — 15 cm long. After its department resect the front branch of a locking nerve which is on an abdomen of a short adductor, then cross the back branch of a locking nerve lying between short and long adductors. After crossing of branches of a locking nerve (and sometimes and before) cross sinews of adductors. Upon termination of operation apply a koksitny plaster bandage with a strut for a period of 2 months. Because adductors are partially innervated also by a sciatic nerve, there is recurrence of a spasm of muscles. At the expressed internal rotation of a hip of operation of crossing of locking nerves and sinews of adductors quite often supplement with an osteotomy of a hip or a section of sinews buttock (average, small) muscles. At flexion contractures in knee joints apply the following operations: removal of sgibatel of a hip, change of a sgibately shin on a patella, Eggers's operation (see). At deformations of feet make sinew, muscles and bones operation. At a bottom inflection of foot Silversheld's operation — separate change of a gastrocnemius muscle is shown (see); Z-shaped lengthening of heelstring. At sharply expressed deformations of feet operations — a resection of perednesredny department of foot or an artificial ankylosis of an ankle joint can be made. In these cases widely apply Shtoffel I's operation: crossing of branches of the sciatic and tibial nerves going to spastic to the reduced muscles, crossing of the branches of a tibial nerve going to gastrocnemius muscles. At spastic deformations of upper extremities typical position of a hand is characteristic: reduction of a shoulder, sharp pronation and bending of a forearm, palmar inflection of a brush and reduction of a finger. All specified provisions are subject to correction as in the conservative ways (plaster redressments), and operational. However owing to multiple muscles of upper extremities and overlappings in their innervation efficiency in treatment considerably decreases. Muscle and sinews operations consist or in their lengthening, or in movement of points of an attachment. Bone and joints operations were not widely adopted. At pro-national ionic installation of a forearm apply a tenotomy of an infrascapular muscle or a subcapital osteotomy of a humeral bone. The bringing contracture of a shoulder is eliminated by crossing of sinews of a big pectoral muscle, a wide muscle of a back and a round muscle (the operation Siskin — Poleyko). Shtoffel II'S operation on a median nerve allows to reach considerable active extension of a brush and fingers. At considerable reduction of the I finger the resection of the trailer fibers of a deep branch of an elbow nerve innervating an adductor of this finger is shown. After active methods of treatment beneficial influence is exerted by sanatorium treatment; removal of plaster bandages in the conditions of independent movement. Forecast of a disease: at easy degree — favorable, average and heavy — adverse.