Single event multilevel surgery on the lower limbs in children with cerebral palsy

Abstract

Introduction. Treatment of children with CP with different pathological settings and multiplanar deformities of the lower limbs in need of systematization and differentiated approach. To compare the efficacy of the differentiated use of simultaneous multilevel interventions in the lower extremities, with the standard phased treatment of pathology of the hip, knee and feet in children with cerebral palsy. Materials and methods. We have examined and treated 125 children with CP, aged 4-16 years, the level of motor activity of GMFCS: in 10 patien - I level, 26 - II level, 29 - III, 37 - IV, 23 - V. The children were divided into two subgroups (primary - 60 patients and the control group – 65). The mean follow-up - 6.4 years. Examination - according to the standard procedures: before and during treatment - clinical, radiographic, biomechanical, neurological, ultrasound, electromyography and muscle dynamometry. Results. In children aged 4-8 years, 27 children of the main group, depending on the severity and type of pathologic deformities of the lower limb joints simultaneously performed soft tissue intervention at the level of the hip, knee, ankle joints and also eliminate the deformity of foot. Postoperatively, main group were provided with orthoses for verticalization and walk or performed immobilization in a cast for 3-4 weeks to maximize the rapid mobilization for 3-5 days after surgery. In the control group intervention performed successively on each of the limbs without performing hemiepiphysiodesis with immobilization by cast. After 4-6 weeks after surgery children from both subgroups were received rehabilitation treatment. In children aged 8-16 years, 33 children of the main group simultaneously were performed soft tissue surgery at the level of the joints of the lower limbs in combination at an interval of 1-1.5 months corrective intertrochanteric hip osteotomy and operations in the pelvic component. The postoperative period was performed similarly to the above principles. Findings. The obtained data of retrospective assessment of long-term results of simultaneous multi-level interventions in the lower extremities authentically indicate the prospects application of this technique in children with cerebral palsy. Due to an early activation, children from the study group have significantly improved locomotor activity compared to the control group.