Outcomes of multilevel orthopedic surgery in children with cerebral palsy
Kenan Koca1, Cemil Yıldız1, Yüksel Yurttaş1, Birol Balaban2, Bülent Hazneci2, Serkan Bilgiç3, Mustafa Başbozkurt1
1Gülhane Askeri Tıp Akademisi Ortopedi ve Travmatoloji Anabilim Dalı;
2Fizik Tedavi ve Rehabilitasyon Anabilim Dalı;
3Acil Tıp Anabilim Dalı Başkanlığı, Ankara, Türkiye;
Keywords: Cerebral palsy; joint kinematics; multilevel orthopedic surgery; time-distance parameters.
Abstract
Objectives: Outcomes of single-event bilateral multilevel orthopedic surgery in children with cerebral palsy were retrospectively investigated by physical findings, and gross motor function measurement (GMFM) score in all patients and additionally by joint kinematics, and timedistance parameters in ambulatory patients.
Patients and methods: A total of 24 patients (17 ambulatory; 7 non ambulatory; mean age 12 years; range 5 to 19 years) treated with multilevel orthopedic surgery between December 2003 and December 2005 were included in the study. Patients were evaluated with physical examination and GMFM score. In addition, computed gait analysis was used to evaluate joint kinematics and time-distance parameters in ambulatory children. The following surgeries were performed on the children in the study cohort: adductor tenotomy (n=24); psoas lengthening (n=14); hamstring lengthening (n=46); distal rectus femoris transfer (18); bilateral Achilles tendon lengthening (n=22); distal femoral derotation osteotomy (n=1); open reduction and Dega osteotomy (n=1), and proximal femur resection (n=2). Patients were evaluated with the same parameters after an average of eight months postoperatively. The pre- and postoperative results were statistically compared.
Results: Improvement were achieved in the lying-rolling (7%), sitting (9%), crawling-kneeling (7%), standing (5%), and walkingrunning- jumping (5%) activities of GMFM score. An increase in hip abduction angle and external rotation and a decrease in the Thomas test results were observed. An decrease in popliteal angle and an increase in active and passive knee extension were provided. Active and passive ankle dorsiflexion increased. In the kinematic parameters, the minimum hip and knee flexions in the stance phase were significantly decreased, while no significant decrease was seen in the maximum hip and knee flexion in the swing phase. Both the ankle dorsiflexion in the stance and swing phase and the timedistance parameters consist of walking velocity, stride length and the cadence were significantly improved.
Conclusion: Single-event bilateral multilevel orthopedic surgery performed in the right indication was shown to be effective with improvements in physical examination findings GMFM scores, joint kinematics and time-distance parameters in children with cerebral palsy.