Clinical Experiences of Poliomyelitis

Chu, Chung Bin

Abstract

This is an analysis of 1282 cases of poliomyelitis from patient records gathered over a 20 year period from the year of 1964. The results are as follows : 1. The most visits recorded in any one year were 301(23%) in 1965. The most visits recorded in a 5 year period were 961(67%) in the years of 1965-1969. 2 Of a total of 1158 cases whose year of onset was recorded, the earliest onset was in 1900: only one case. Since 1981 no new onsets have been recorded. However, the majority of cases : 1014(87%) showed an onset between 1955-1974. 3. Of a total of 1282 cases whose place of residence at primary examination was recorced, 891(70%) resided in Seoul and 391(30%) in the rural areas. 4. Of a total of 1282 cases whose sex was recorded, males comprised 777(61%) and females 505(39%). 5. Of a total of 883 cases whose season of onset were recorded: 526(60%) onsets occured in the warm, 272(31%) in the cool, and 85(9%) in the cold season of yesr. 6. Of a total of 1155 cases whose age at onset was recorded, the youngest was 4 months and the oldest 28 years of age. The largest group comprising 915 cases(79%) were two years of age or younger. 7. Of a total of 1146 cases whose period between onset and primary visit was recorded: 182(16%) were in acute, 414(36%) were within convalescent, and 732(64%) were in residual stage. 8. Of a total of 1268 cases whose age at initial examination was recorded, 233(18%) were two years or younger, 1021(81%) were 14 years or younger. 9. Of a total of 445 cases whose vaccination history was recorded, 234(53%) had been vaccinated prior to onset. Of those only 112(48%) had completed the required course of vaccincation. 10. Of the total of 1282 cases, deformities resulting from muscular paralysis were recorded in 1099(86%) cases. The number of deformities occuring in these cases totalled 3141: 189 deformities(6%) were in the trunk, 64(2%) were in upper extremity, and 2888(92%) were in lower extremity. Among the lower extremity, 1270(40%) were in the foot. The most frequent single deformity was knee flexion with the total of 464(15%). 11. Of a total of 798 cases whose leg length was verified, 394 were measured by scanogram and 404 cases by measurement of actual leg length. The greatest leg length discrepancy was 12cm in a 17 year-old male, and the most average discrepancy in those bone growth completing, age of 17-20 years, was 3.2cm. 12. Of a total of 1282 cases, 503(39%) cases had prescriptions for supportive devices, but only 316(25%) cases actually had made and wore them. Among those prescriptions, the most common type prescribed was the long-leg brace, which totalled 351. 13. Of the total of 1282 cases, 449(35%) received 1297 surgical procedures, an average of 2.9 per patient. The operations on soft tissue comprised 734(57%) procedures : 348 tendon transplantations with the most(170 procedures) on peroneals, 147 tendon lengthenings with the most(146 procedures) on Achilles tendon, and 234 fasciotomies with the most (117 procedures) on iliotibial band. The operations on bone and joint comprised 563(43%) procedures : 274 leg length equalizations with the most(172 procedures) of growth stimulation, 186 arthrodeses with the most(115 procedures) of triple arthrodesis of the foot, and 92 osteotomies with the most(41 procedures) on tibis. 14. Since problems remaining in the residual stage of poliomyelitis are almost always permanent, observation of these cases over a long period of time has generated invaluable experience from which we have gained considerable knowledge. 15. It has been a revelation to see the considerable degree of compensation in growing children such as a decrease in leg length discrepancy as the end of growth approached. Cases of so called hand-knee gait showing hypertrophy of fingers have lost this in a few years, following corrective measures. 16. We feel that all cases of leg length discrepancy do not need to be treated uniformly, considering the power of the ability of growing children to compensate without any inter vention. 17. Prediction of type of motion or deformities using physical examination of muscular paralysis is very difficult because the compounding factors of not only the paralysis of various muscles but the individual characteristics. The age, sex, lifestyle, motivation etc. have been shown to have an over-riding influence. 18. Decisions to brace or operate should not be made hastily but only after careful and thorough examination. We saw many quite severely disabled cases walk remarkably well without braces or surgery by their own means of compensation or device. 19. Cases with almost no lower extremity muscle power except for 20-30% hip rotators could walk surprisingly well using the sartorius muscle as a main controlling force. So we dubbed their manner of walking the sartorius gait. 20. Bracing can be very burdersome, and decisions to brace should not be made on the textbook alone. Some cases happily choose surgery over bracing. 21. For one time surgical procedure, it is better to choose bone over soft tissue for a better result. When the surgery is two stage, soft tissue surgery done after bone and joint surgery has healed will produce better results. 22. We must all realize that not only poliomyelitis, but also all chronic diseases need mental treatment as well as physical. Because, in rehablitation mental disablity is more harmful than physical in the final analysis.