Гений oртопедии (Dec 2019)
Correction of torsion deformities in adolescents and adults with cerebral palsy, impact on gait parameters
Abstract
Purpose To evaluate the changes in gait parameters in patients over 16 years old with cerebral palsy who underwent detorsion osteotomy in the lower extremities as part of multilevel interventions. Materials and methods This retrospective study evaluated functional treatment results of 32 adolescents and adult patients (average age, 23.4 ± 6.5 years). Included were patients with cerebral palsy, able to move independently and having clinically significant torsion deformities of the lower limb bones. Exclusion criteria were age younger than 16 years, as well as patients with stiff knee gait and crouch gait. All patients underwent multilevel single-event surgical interventions, including detorsion osteotomy. Gait analysis using the Edinburgh visual gait score was conducted before surgery, and 1.5– 2 years after the interventions. Patients were divided into group 1 who had no previous surgical interventions, or had undergone the Strayer operation, and group 2 after surgical interventions such as lengthening of the Achilles tendon or fibromyotomy in the early age. Results Before the operation in group 1, the changes in the parameters corresponded to true equinus gait or jump gait in combination with internal rotation of the lower extremities. Correction of torsion deformities of the femurs improved the orientation of the knee joints. In the support phase, improvements were recorded for initial contact, heel lift, maximum dorsiflexion of the foot, rotation and obliquity of the pelvis. In the non-support phase of the cycle, clearance, maximum dorsiflexion of the foot, and peak flexion of the knee joint improved. Before the operation in group 2, the changes corresponded to true equinus gait in combination with the internal rotation of the knee joints in the support phase in five subjects. In the remaining patients, torsion was combined with the initial contact produced by the forefoot due to excessive bending of the knee joint at the terminal swing of the non- support phase, followed by late heel lift and insufficient knee joint straightening in the support phase. It can be explained by weakening of the triceps due to previous operations. Correction of the femur significantly improved the orientation of the knee joint. In the support phase of the cycle, improvements were in the initial contact, heel lift, maximum dorsiflexion of the foot, and pelvic rotation. Lengthening of the knee flexors enabled to improve the maximum extension of the knee joint in the support phase of the gait cycle in all patients. No improvement in trunk balance was found in either the first or second group in the long-term period. Differences were statistically significant by comparing the parameters between the groups before surgery according to the Mann-Whitney criterion showing better results in patients of group 1. The result in the long-term period did not show statistically significant differences. Conclusion Correction of torsion deformities of the lower extremities in adolescents and adult patients with cerebral palsy as part of multilevel single-event interventions results in improvement in many gait parameters and the overall total score. During the follow-up period of 1.5-2 years after surgery, there was no improvement in the parameters of the trunk balance by walking. Patients who underwent early surgical interventions in childhood had worse walking parameters before surgery than the patients not operated previously.
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