Analysis of the literature data on the surgical treatment of feet deformities in children with cerebral palsy allowed determining of the first key pathogenesis aspects and management of surgical treatment. The main types of changes occurring in the feet under the influence of spastic disorders and the optimal methods of progressive deformities of feet surgical treatment were studied. The treatment management preference depends on intrapatient habits, age, the pattern of rescue, deformation gravity and mobility, level of the gross motor function (GMFCS). Various «soft tissue surgery» forms are effective provided sufficient deformation mobility for younger children group patients. The bone-cutting feet surgical measures are justified provided rigid deformations in more older children. A differentiated neurogenic feet deformities surgical treatment approach provides obtaining both early and long-term satisfactory treatment results.
Purpose. to analyze the effectiveness of soft tissue surgical correction of equine-flat-valgus-feet deformity in children with cerebral palsy. Material and methods. A retrospective analysis of clinical and X-ray findings of 47 patients (86 feet) with equino-flat-valgus deformity was performed. All patients were treated surgically. They were divided into two groups by age: Group I - 23 children (4-7 y.o.); Group II - 24 children (8-11 y.o.). The neurological status was examined in patients with the motor development of level I - III (by GMFCS classification) who had hemiparesis, diplegia and tetroparesis. A comparative analysis was made with a reference group which consisted of 30 children (56 feet), aged 4-11, who had exostotic chondrodysplasia or trauma of the ligamentous apparatus in one foot without neurological pathology and feet deformities. Results. One year after surgery, a significant improvement in clinical and radiological parameters comparing to preoperative findings was registered in patients of both studied groups. Most parameters were close to the established reference intervals. In Group I, three years later at the follow-up examination no significant difference was revealed in similar parameters obtained three years later and one year later after the surgery. However, in Group II three years later a negative dynamics was seen in most of studied parameters when compared with reference values and with results of the first postoperative year. Such outcomes demonstrate high efficiency of soft foot tissue surgery in children under 8. A significant decrease in clinical and radiological parameters after similar amount of surgical correction in children of primary school age (8-11 y.o.), which were under the long-term observation, may indicate the ineffectiveness of such techniques at this age. Evaluation of the functional status by the Gillette functional assessment scale three years after the surgery revealed the increased functional status in 78.26% of patients from Group I and in 41.66% from Group II. In some children from Group II (primary school age), there was a negative dynamics in their functional status. Conclusion. In generally, the obtained data indicate good prospects for improving the functional status in the postoperative period in children of both groups. However, the existing negative dynamics in children from Group II (8-11 y.o.) indicates a weak prospective for a long-term surgical deformity correction of the foot ligamentous apparatus because the coming period is a period of rapid growth and increased loading on the musculoskeletal system of a child with cerebral palsy.
The review of actual directions of optimization of surgical treatment of locomotor disorders in spastic forms of infantile cerebral palsy is presented. When choosing the tactics of the treatment for this category of patients, the following criteria should be taken into account: the degree of disturbances in motor activity associated with muscle tone disorders, the spasticity pattern, the presence of joint contractures, limb deformities, the level of intellectual development, the presence and severity of perceptual disorders. The implementation of simultaneous operations allows reducing the period of immobilization of the child and the period of temporary incapacity for work of parents and recommended for the treatment of patients with cerebral palsy at all levels of the Gross Motor Function Classification System (GMFCS). There are considered modern methods of surgical treatment of spastic instability of the hip when the choice of the method of correction of the acetabular component of instability depends on the degree of abnormalities of the anatomy of the acetabulum, mainly from the deficit of the bone covering of the head of the femur and the «slanting» of the roof of the acetabulum. In the treatment of contractures of knee joints in order to prevent сrush syndrome, the elongation of the medial group of tibial flexors is advisable to be used in conjunction with tonus-enhancing operations in the anterior group of femur muscles with their secondary weakness. When treating axial deformities of the knee joints and unequal length of the legs, it is important to observe the timeliness principle (during the active growth of the skeleton) with the use of minimally invasive surgical interventions - hemi and epiphysiodesis - to avoid the need for more traumatic interventions.
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