The results of acute multilevel surgical interventions in patients with children cerebral palsy

Аранович А.М., Попков А.В., Щукин А.А., Медведева С.Н., Евреинов В.В., Третьякова А.Н., Зыков А.Г., Климов О.В., Парфенов Э.М., Lascombes P.Н., Попков Д.А.

Abstract


Introduction. The modern concept of surgical orthopedic treatment of children with cerebral palsy involves performing multilevel orthopedic interventions.
Purpose. To study the results of acute multilevel orthopedic interventions in the lower limbs of patients with children cerebral palsy (CCP) within 8-12 months after surgery.
Material and Methods. The results of surgical orthopedic treatment studied in 108 patients (11.3±1.7 years). The gait analysis by Edinburgh Gait Assesement criteria made in addition to clinical and X-ray methods of studying. Changes in motor activity studied according to Gillette scale. 141 surgical intervention performed in our series, and it included 647 surgical elements on the whole, that is 4.59 ones per surgery on the average.
Results. The gait analysis demonstrated the improvement in most parameters of the support and swing step phase in patients capable of independent ambulation. According to Gillette scale, no increase in functional motor abilities observed in 32 cases (39.02%), one-level increase observed in 47 cases (57.32%), two-level one – in three patients (3.66%).
Conclusion. Performing acute multilevel orthopedic surgeries in patients with CCP means interventions on the limb musculotendinous system and/or bones of two or more anatomical areas during one surgical procedure, or the surgeries on the limbs, due to their significant volume, performed with a short interval (3-6 weeks) during one and the same period of hospitalization further accompanied by a single period of rehabilitation. This approach requires using the adapted methods of surgical intervention (aponeurotomy, primary stable osteosynthesis), adequate procedures of anesthesia, and pain syndrome control postoperatively in order to start rehabilitative measures early. The compliance with the above principles allowed to achieve the required correction of palsy orthopedic complications in all the cases. Herewith the increase in functional abilities one year after the surgery observed in 49 of 81 patients.

Keywords


children cerebral palsy, spastic diplegia, spastic hemiplegia, dyskinetic form, correcting osteotomy, varus derotation osteotomy, locked plate, plate with angular stability, arthrodesis, aponeurotomy, threaded wire, single-event multilevel surgery

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