Polio is a severe infectious disease caused by the virus polio infection through the virus enters the body of the child by mouth or inhalation and then the virus to the central nervous system through the blood and settle in the cells of the spinal cord (preferred position), causing paralysis of peripheral nerves . The disease has been known since the first half of the 19th century and the first reports and descriptions were received by Badham in England in 1834.
There are three types of this virus – types I, II and III – and these types of immunity are not common and therefore, the vaccines are different since it is possible to infect the same person in the three species.
Clinically, there are also three types of infection. In the first type, symptoms are similar to light-sore symptoms. Most of these symptoms end within one week without clinical effects.
In the second type, the symptoms are symptoms of viral meningitis without polio.
In the third type, symptoms with signs of meningitis then develop into paralysis.
In this type of paralysis disease develops through three stages:
1. Acute phase (5 to 10 days), paralysis usually begins three days after the onset of fever, paralysis fever accompanied by symptoms such as headache, hardening of the neck muscles painful cramps.
Some cases are affected by the brain stem and this is associated with paralysis of the breathing muscles.
2. Recovery stage, which is up to 18 months and then an automatic improvement may occur.
3. Chronic stage – the stage of stability of the disease with a paralysis of the muscles and where the final determination of the size of the damage to the muscles and was paralyzed completely or partially.
The spread of paralysis on the muscles of the lower limbs limits the patient’s ability to walk at varying degrees. When one leg is normal and the muscles are good, and the other is paralyzed, it is difficult for the patient to walk without external support to the paralyzed limb. The position of the knee joint is forced to force the patient to put his hand on his thigh to back it to be supported and can carry weight. When the quadriceps are completely paralyzed, walking is almost impossible without the use of external support devices.
In these circumstances, the adjustment of the position of the knee becomes very vital and allows the knee joint to be unique and will necessarily lead to an amazing improvement in the patient’s walk and will be able to dispense with the devices and the use of the hand to support the knee joint. The manual knee is tired and painful to the extreme and also has negative effects on the psyche. These patients are often exposed to falls that may result in fractures in the limbs.
Non-joint fixation leads to corrosion, damage and friction to all joints involved in the process of walking. Excessive pressure on the joints of the right limb accelerates the appearance of monotonous osteoarthritis, as the injured party is usually lagging behind in growth and is usually shorter and this causes fatigue of the healthy limb.
For more than a century, doctors and surgeons have sought to find ways and means to help people with paralysis. There have been many suggestions for surgical treatment as well as dozens of external devices supporting muscles and limbs to help patients and alleviate their pain and suffering.
This began in 1987 and attempts have continued to this day. Although there are tremendous successes in this area, the diversity and functional and structural diversity of the disease remains a clear obstacle to the near-final solution.
It is very possible to divide the stages of surgical treatment of the polio problem to two basic stages:
1- The first stage Which lasted about 90 years, and this phase was characterized by the accumulation of information on the disease and how to develop and find vaccines and prevention campaigns around the world, which states that Jordan was one of the first countries in the world that paid great attention and achieved successes Very early in the prevention of this vicious and contagious disease. At this stage, dozens of reconstructive surgeries have been proposed for the parties to help walk and relieve suffering. This was in the pre-Yazarov era. In this particular age, the disease did not exclude even US President Roosevelt, who was injured at a relatively late age.
2. Phase II And the age of about 40 years – is the stage of Yazarov – as the results of treatment began to appear – and it can solve several problems at once – for example, it is possible to modify the hip axis and the length of the leg and adjusting the position of the foot and ankle stabilization at once, Which leads to a huge improvement in walking and disposal of the use of hand and supporting devices and chronic pain and also to obtain the effects of tensile bone, including improved blood circulation in the limbs. Despite the daily problems, complications and daily complications of Yazarov during treatment, this method has been a major breakthrough in the surgical treatment of polio-endemic patients.
The surgical or conservative treatment of knee joint flexion and the attempt to dispose of hand-assisted walking depends primarily on the degree of flexion. Some surgeons say there are two groups and some divide them into three groups, and this is what we also adopt (Leong JC, Alade CO, Fang D.).
The first group Limited to 15 degrees or less; it can be treated conservatively.
the second group The angle is limited from 15 degrees to 50; it can not be treated conservatively, and surgery can be performed to modify the axes by cutting the lower thigh.
Group III Limits of more than 50 degrees are preferred. This type of treatment is preferred in two stages – the posterior release of the soft tissue of the knee joint to obtain angle 50 and below. The second stage is surgery to modify the axes by cutting the lower thigh
These surgeries, when performed according to the indications and when used with the Yazarov method, give good results, we will present them later.