The role of neurogenic feet deformities in the lower limb dysfunction structure in patients with cerebral palsy. Management of surgical treatment. Literature data review

Яцык, С. П.; Zherdev, K. V.; Zubkov, Pavel A.; Pak, Lale A.; Volkova, Maria O.; Chelpachenko, O. B.; Петельгузов, А. А.

doi:10.21518/2079-701x-2018-11-162-167

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…При хирургическом лечении детей, имеющих эквино-варусные стопы на фоне генетических болезней и патологии ЦНС, когда деформация стоп постоянно рецидивирует, выполнение малоинвазивных операций дает кратковременный эффект даже при условии тщательного соблюдения послеоперационного ортезно-брейсового лечения. Поэтому таким пациентам необходимы более «агрессивные» вмешательства -обширные релизные мягкотканные операции в сочетании с остеотомиями, артродезирующими процедурами и транспозициями сухожилий [15,16]. Так, остеотомия внутренней лодыжки с низведением ее выполнена 2 пациентам; остеотомия (остеоклазия) большеберцовой кости на уровне дистального метафиза в возрасте старше 2,5-3 лет при ригидной форме эквино-варуса стопы -3 пациентам; остеотомия пяточной кости по Dwyer, показанная при неисправимой варусной деформации заднего отдела стопы, обусловленной деформацией самой пяточной кости, выполнена 1 ребенку [12].…”

Section: таблица 1 оценка результатов лечения косолапости по методу и понсети Table 1 Evaluation Of the Results Of The Treatment Of Clubfunclassified

“…Так, остеотомия внутренней лодыжки с низведением ее выполнена 2 пациентам; остеотомия (остеоклазия) большеберцовой кости на уровне дистального метафиза в возрасте старше 2,5-3 лет при ригидной форме эквино-варуса стопы -3 пациентам; остеотомия пяточной кости по Dwyer, показанная при неисправимой варусной деформации заднего отдела стопы, обусловленной деформацией самой пяточной кости, выполнена 1 ребенку [12]. Трехсуставной (тройной) артродез стопы -операция, которую делают детям старше 9 или 10 лет (когда естественный рост костей завершается) с жестким каво-варусным уродством при сохранении удовлетворительных движений в голеностопном суставе, выполнена 20 пациентам в сочетании с транспозициями сухожилий [3,12,15]. Не утратил своих пози-…”

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Rational selection of treatment methods in recurrent clubfoot

Дивович

2021

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Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumﬂex joints and without damage to the ﬂexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

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Rational selection of treatment methods in recurrent clubfoot

Дивович

2021

jour

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Elongating achilloplasty and the original tenorraphy technique for cerebral palsy

Guryanov,

Studenov,

Averyanov

et al. 2023

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND:In cerebral palsy, shortening of the triceps muscle of the lower leg leads to impaired coordination and gait and orthopedic consequences that disrupt the quality of life and complicate rehabilitation. Many surgical techniques are aimed at eliminating contractures and restoring ankle joint movements. However, treatment results are not always satisfactory, and the number of complications remains high, such as recurrence of deformation and failure of the tendon suture after tenotomy. AIM:To analyze the results of calcaneal tendon lengthening plastic surgery with the original tendon suture technique in patients with cerebral palsy complications and consider the features of surgical technique onaclinical example. MATERIALS AND METHODS:This study describes the lengthening plastic surgery of the calcaneal tendon with the original tendon suture technique performed in four patients with complications of cerebral palsy. The clinical observations of the surgical treatment ofa30-year-old patient with spastic paresis of the triceps muscle of the left tibia were presented. The treatment results were followed from 1 to 12 months postoperatively. The amplitude of active and passive movements in the joints, muscle tone, presence and nature of postoperative complications, and functional outcome were evaluated. RESULTS:The results 1 year after the operation were evaluated as good in two initially more severe cases and excellent in two cases. In all patients, decreased pain level, restoration of movements, decreased hypertension, and hypotrophy of the triceps muscle of the lower leg were observed, and no complications were noted. CONCLUSIONS:The results revealed data on the pathogenetic validity of calcaneal tendon elongation in patients with spastic paralysis of the triceps muscle of the lower leg. The proposed original method of surgical treatment ensures the correct anatomical comparison and density of the contact of the tendon ends, reduces the tone of the calf-flounder complex, preserves joint physiological mobility, begins early rehabilitation, and reduces the likelihood of relapse.

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A Surgical Correction of the Tendon - Muscular Apparatus in Equino-Flat-Valgus Feet in Children With Cerebral Palsy

Zubkov

Zherdev

Chelpachenko

et al. 2020

Russian Journal of Pediatric Surgery

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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.

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The role of neurogenic feet deformities in the lower limb dysfunction structure in patients with cerebral palsy. Management of surgical treatment. Literature data review

Cited by 3 publications

References 29 publications

Rational selection of treatment methods in recurrent clubfoot

Rational selection of treatment methods in recurrent clubfoot

Elongating achilloplasty and the original tenorraphy technique for cerebral palsy

A Surgical Correction of the Tendon - Muscular Apparatus in Equino-Flat-Valgus Feet in Children With Cerebral Palsy

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