Díaz-Vázquez J, Peralta-Cruz S, Olín-Núñez JA, Redón-Tavera A

Language: Spanish
References: 14
Page: 376-384
PDF size: 74.56 Kb.

ABSTRACT

The purpose of this study is to assess the effects of multiple level surgery of the pelvic limbs in patients with spastic infantile cerebral palsy seen at the National Rehabilitation Institute and show that their clinical improvement is comparable to the reports in the national and international literature. Material and methods: This is a longitudinal, prospective, descriptive, self-controlled, before-and-after clinical trial that included patients with spastic infantile cerebral palsy who underwent multiple-level single-stage surgery from January 2007 to August 2008. The inclusion criteria were as follows: both genders, ages 4 to 16 years, with a complete clinical file, with preoperative and 8-12 month postoperative rehabilitation. Elimination criterion: any event not related with multiple-level surgery. Exclusion criterion: any surgeries prior to admission. A descriptive statistical analysis was used, together with the Student t-test and the chi-square test. Results: 81 patients with a mean age of 7 ± 3.2, an age range of 4-16 years; 60.5% males and 39.5% females. The subtypes of spastic infantile cerebral palsy were as follows: biparesis 64.2%, quadriparesis 22.2%, hemiparesis 8.6%, double hemiparesis 4.9%. The clinical-surgical classification (14) changed as a result of improvement and according to the number of surgical procedures: 6 patients (7.4%) had significant improvement (p = 0.13) with one procedure; 44 patients (54.3%) had significant improvement (p = 0.002) with two procedures; 28 patients (34.6%) had significant improvement (p = 0.04) with three procedures, and 3 patients (3.7%) had significant improvement (p = 0.19) with four procedures. On the other hand, when the number of surgical procedures was related with the diagnostic subtype of spastic infantile cerebral palsy, in those undergoing one procedure the clinical-surgical classification did not change in the cases of biparesis (p = 0.26), hemiparesis (p = 0.18), and double hemiparesis (p = 0.50). In those undergoing two surgical procedures the significant changes occurred for the cases of biparesis (p = 0.20), quadriparesis (p = 0.007), and double hemiparesis (p = 0.16). In those undergoing four procedures no changes occurred in the cases of biparesis (p = 0.26) and hemiparesis (p = 0.50). Discussion:An improvement in the clinical-surgical classification was observed (p = 0.0001) based on the results of Gazi Zorer, as well as a significant improvement (p ‹ 0.001) and an improvement reported by the gait analysis by the following authors: Ugur Sayli, Gouth, MA Khan.

REFERENCES

1. Guerrero ZB, Martínez LR: Integración de personas con discapacidad: Sin diferencias. 2005; 5(15): 6-16.

2. Redón TA, Medinaveitia VJA, Arellano SE, Olín NA, Viñals LC, Peralta CS, Del Valle CMG, Vázquez EJ: Clínica de parálisis cerebral infantil en el Instituto Nacional de Rehabilitación. Acta Ortop Mex 2006; 20(4): 145-9.

3. Matsuo T: Cerebral palsy: Spasticity-control and orthopaedics. An introduction to orthopaedic selective spasticity-control surgery (OSSCS), Soufusha, Tokyo, 2002.

4. Koman LA, Smith BP, Shilto JS: Cerebral Palsy. Lancet 2004; 363: 1619-31.

5. Ugur Sayli, Sinan, Ayse: Simultaneous multiple operations for the lower extremity contractures of spastic cerebral palsied patients: Klinik Arastirma/Clinical Research 1999; 10(2): 160-4.

6. Universia México: Parálisis cerebral, primer lugar de discapacidad en niños. Boletín Red de Universidades Red de Oportunidades. 2007.

7. Renshaw TS, Green NE, Griffin PP, Lee R: Cerebral palsy: Orthopaedic management. J Bone Joint Surgery Am 2008; 77: 1590-606.

8. Sharan D: Recent advances in management of cerebral palsy: Indian J Paediatric 2005; 72(11): 969-73.

9. Metaxiotiis D, Wolf S, Doederlein L: Conversion of biarticular to monoarticular muscles as a component of multilevel surgery in spastic displegia: J Bone Joint Surg Br 2004; 86-B(1): 102-9.

10. Gough M: The outcome of surgical intervention for early deformity in young ambulant children with bilateral spastic cerebral palsy. J Bone Joint Surg Br 2008; 90-B(7): 946-51.

11. Khan MA: Event multilevel surgery in untreated cerebral palsy in a developing country. J Bone Joint Surg Br 2007; 89-B(8): 1088-91.

12. Gordon AB, Glen OB: Gait analysis outcomes of percutaneous medial hamstring tenotomies in children with cerebral palsy: J Paediatric Orthop 2008; 28(3): 324-9.

13. Zorer G, Cemal D: The results of single-stage multilevel muscle-tendon surgery in the lower extremities of patients with spastic cerebral palsy. Acta Orthop Traumatol Turc 2004; 38(5): 317-25.

14. Redón TA: Universal two stage clinical-surgical classification for patients who have cerebral palsy. Tachdjian 22 Paediatric Orthopaedic. 1994; 1: 109-15.