Soft tissue release and osteotomies in the treatment of patients with spastic diplegic cerebral palsy

Abstract

We aim to study the outcome of soft tissue releases by tendon elongations and osteotomies in fixed joint contractures by clinical examination and patient self-reported assessment on 20 patients (14 males and 6 females) with spastic diplegic cerebral palsy treated with single-event multilevel surgery (SEMLS) between 2000 and 2012. A questionnaire was used to collect information on problems encountered before and after surgery and decision on surgery. Comparing patients with Gross Motor Function Classification System class I/II, (N = 8), III (N = 8) and IV/V , patients of classes IV/V showed much slower mean recovery time than I/II group (14.00 vs. 4.38 months, p < 0.01). SEMLS in the treatment of patients with spastic diplegia had good mid-term results in most patients. The patients who had unfavourable outcomes are associated with mental retardation, general or local complications and previous selective dorsal rhizotomy surgery. Patient selection and good rehabilitations preoperation and postoperation provided the most favourable outcomes of SEMLS. 中 文 摘 要: 我們的目的是通過臨床檢查和患者自我報告，評估20例（男14例，女6例）痙攣型雙癱性腦癱患者在2000年至2012年之間進行單次多層手術治療（SEMLS），研究以肌腱延長和截骨術等軟組織鬆解治療固定關節攣縮弛的結果。使用問卷收集手術前後遇到的問題以及手術決定的信息。比較粗大運動功能分類系統運GMFCS I / II級（N = 8）、III（N = 8）和IV / V組患者的平均恢復時間比I / II組慢（14.00比4.38個月，p <0.01）。 SEMLS治療痙攣型雙癱性腦癱在大多數患者中有良好的中期療效。不良後果的患者與弱智、全身或局部並發症以及先前選擇性背側神經根切斷術相關。患者選擇、手術前後的良好康復提供了SEMLS最有利的結果。 Keywords: osteotomy, cerebral palsy, single-event multi-level surgery