Comparative effects of multilevel muscle tendon surgery, osteotomies, and dorsal rhizotomy on functional and gait outcome measures for children with cerebral palsy.

Autor: Feger MA; Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(∗). Electronic address: mf3de@virginia.edu., Lunsford CD; Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(†)., Sauer LD; Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(‡)., Novicoff W; Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(§)., Abel MF; Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(¶).
Jazyk: angličtina
Zdroj: PM & R : the journal of injury, function, and rehabilitation [PM R] 2015 May; Vol. 7 (5), pp. 485-93. Date of Electronic Publication: 2014 Nov 20.
DOI: 10.1016/j.pmrj.2014.11.002
Abstrakt: Objective: To compare the impact of common surgical interventions (selective dorsal rhizotomy, muscle-tendon surgery, and osteotomies) for patients with cerebral palsy (CP) on Gross Motor Function Measure and temporal, kinematic, and kinetic gait variables as assessed via 3-dimensional motion analysis.
Design: Retrospective cohort study.
Setting: Motion analyses laboratory.
Participants: Ninety-four patients with CP, 56 of whom underwent surgery (37, muscle-tendon surgery; 11, osteotomy; and 8, selective dorsal rhizotomy) and 38 of whom did not have surgery; the patients were ages 4-18 years, with a Gross Motor Function Classification System classification of I, II, or III.
Interventions: Single-event, multilevel muscle tendon surgery, selective dorsal rhizotomy, and osteotomy.
Main Outcome Measures: Change scores (postintervention - preintervention) in Gross Motor Function Measure and temporal, kinematic, and kinetic gait variables.
Results: No statistically significant differences in change scores were found between groups in the Gross Motor Function Measure, velocity, or stride length measures after the observation period. The selective dorsal rhizotomy group had greater improvements in knee extension when compared with the nonsurgical group and greater hip and knee total range of motion during the gait cycle when compared with nonsurgical group and the muscle-tendon surgery and osteotomy cohorts. Lastly, the muscle-tendon surgery group had greater improvements in total knee range of motion compared with the nonsurgical group.
Conclusions: Patients who undergo selective dorsal rhizotomy and, to a lesser extent, muscle tendon procedures demonstrate greater improvements in kinematic gait variables compared with nonsurgical interventions in patients with spasticity resulting from CP.
(Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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