RESUMEN
BACKGROUND: Pes planovalgus (PPV) deformity is common among cerebral palsy (CP) patients. There is no true consensus about the best way of treating this common deformity, especially when surgical interference is required. Treatment options range from orthotics to complex surgical procedures. The purpose of this prospective study was to evaluate and compare the effectiveness of 2 different procedures in the correction of symptomatic flexible PPV in ambulatory CP patients. METHODS: A total of 57 feet in 35 patients were divided into 2 groups: group 1, subtalar arthroereisis group, using the calcaneostop technique; group 2, lateral column lengthening group, using Evans osteotomy. Patients were assessed clinically by the clinical score proposed by Yoo et al and radiologically by measuring 7 weight-bearing angles, both preoperatively and 12 months postoperatively. Patients' (or parents') satisfaction and their tolerance to braces or shoes were assessed 12 months after surgery as secondary outcome parameters. RESULTS: There was a statistically significant improvement in both primary and secondary outcome parameters after both procedures in comparison to the preoperative parameters. No statistically significant differences were observed between the 2 groups regarding the outcomes of both procedures except for the greater power of arthroereisis in the correction of hindfoot valgus, which was statistically significant both clinically and radiographically. CONCLUSION: Both procedures are valid options for the surgical management of PPV in ambulatory children with spastic CP. The less-invasive nature and lower potential morbidity suggest that judicious use of arthroereisis is appropriate for some patients, especially in the context of single-event multilevel surgery. LEVELS OF EVIDENCE: Level II: Prospective, comparative study.
Asunto(s)
Calcáneo , Parálisis Cerebral , Pie Plano , Niño , Humanos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/cirugía , Estudios Prospectivos , Calcáneo/diagnóstico por imagen , Calcáneo/cirugía , Pie Plano/diagnóstico por imagen , Pie Plano/cirugía , Pie/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
The aim of this study was to evaluate the efficacy of pamidronate in the management of osteogenesis imperfecta patients. This study was carried out in two groups. The first was treated only surgically whereas the second was treated by a combined approach, medical and surgical. Forty patients, divided into two groups, were surgically treated in order to correct bony deformities secondary to osteogenesis imperfecta. Group 1: twenty patients were operated at an average age of 6.5 years. Nine were type I, five type III and six type IV. Group 2: this group consisted of 20 patients to whom intermittent intravenous pamidronate were given at regular intervals for an average of 2 years postoperatively. The average age at surgery was 8.5 years. Four patients were type I, six type III, eight type IV, one type V and the remaining one type VII. The results were assessed according to a scoring system suggested and used by the authors since 1999. Group 1: we had three good, nine fair and eight poor results. Group 2: we had 11 excellent, four good and five fair results. The Bone mineral dens (BMD) increased by an average of 35.2% (22.7-112%), and the rate of refracture decreased. Best results in the management of patients can be obtained through the combined approach (surgical and medical treatment). We now advise preoperative and postoperative pamidronate for these patients.