RESUMO
BACKGROUND: Good outcomes have been described after single-event multilevel surgery (SEMLS) in cerebral palsy (CP); however, there is limited evidence regarding factors influencing them. RESEARCH QUESTION: What were the factors related to kinematic outcomes after SEMLS in the present study? METHODS: Two hundred and fifty-eight patients with spastic diplegic CP, GMFCS I-III, who underwent SEMLS and had done pre and post-operative gait analyses were included in the SEMLS Group (SEMLS-G). A second search was performed in the same database looking for patients to compose the Control Group (CG), and 88 subjects, with at least two gait analyses and with no surgical intervention between tests, were identified. Demographic data, GDI and GPS (Gait Profile Score) were analyzed in both groups, and the results compared. A second evaluation was performed in the SEMLS-G in order to identify the influence of age, gender, follow-up time, pre-operative GDI, GMFCS and gait velocity on results. RESULTS: The GDI (51.3-58.4) and GPS (2.5°) improvement occurred only in SEMLS-G (p < 0.001). On sagittal plane, there was an improvement at the knee and ankle levels in SEMLS-G, whereas the pelvic alignment improved in the CG. In SEMLS-G, patients with improvement on GDI > 10 points had lower pre-operative GDI (46.15) than other groups (p < 0.001). In addition, patients with reduction on GDI after intervention had lower pre-operative gait velocity than subjects with improvement >10 points (p = 0. 01). The increase on GDI after SEMLS was greater in patients GMFCS I and II than GMFCS III (p = 0.003). There was a negative effect of GMFCS III on GDI improvement after intervention (p = 0.014). SIGNIFICANCE: Lower pre-operative GDI, higher baseline gait velocity and GMFCS levels I and II were related to better outcomes after SEMLS in the present study. On the other hand, patients GMFCS III were more susceptible to deteriorate after SEMLS.
Assuntos
Paralisia Cerebral/cirurgia , Marcha/fisiologia , Fenômenos Biomecânicos , Criança , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
The aim of this study was to evaluate the influence of the Gross Motor Function Classification System (GMFCS) on the outcomes of rectus femoris transfer (RFT) for patients with cerebral palsy and stiff knee gait. We performed a retrospective review of patients seen at our gait laboratory from 1996 to 2013. Inclusion criteria were (i) spastic diplegic cerebral palsy, (ii) GMFCS levels I-III, (iii) reduced peak knee flexion in swing (PKFSw<55°), and (iv) patients who underwent orthopedic surgery with preoperative and postoperative gait analysis. Patients were divided into two groups according to whether they received a concurrent RFT or not at the time of surgery: non-RFT group (185 knees) and RFT group (123 knees). The primary outcome was the overall knee range of motion (KROM) derived from gait kinematics. The secondary outcomes were the PKFSw and the time of peak knee flexion in swing (tPKFSw). We observed a statistically significant improvement in KROM only for patients in the RFT group (P<0.001). However, PKFSw and tPKFSw improved in both groups after surgery (P<0.001 for all analyses). In the RFT group, the improvement in KROM was observed only for patients classified as GMFCS levels I and II. In the non-RFT group, no improvement in KROM was observed in any GMFCS level. In this study, patients at GMFCS levels I and II were more likely to benefit from the RFT procedure.
Assuntos
Paralisia Cerebral/complicações , Deformidades Articulares Adquiridas/cirurgia , Articulação do Joelho/cirurgia , Atividade Motora , Músculo Quadríceps/cirurgia , Adolescente , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Marcha/fisiologia , Humanos , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/fisiopatologia , Articulação do Joelho/fisiopatologia , Masculino , Procedimentos Ortopédicos/métodos , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Objetivo: Avaliar a influência do alongamento cirúrgico dos isquiotibiais mediais sobre o arco de movimento dos joelhos quando este procedimento foi combinado com a transferência do reto femoral. Métodos: Vinte e quatro pacientes com paralisia cerebral tipo diparesia espástica foram analisados de maneira retrospectiva. Os pacientes que foram submetidos à transferência do reto femoral para flexor de joelho sem o concomitante alongamento dos isquiotibiais mediais (n = 12) formaram o grupo A, enquanto que o grupo B (n = 12) foi constituído por pacientes em que estes procedimentos foram combinados. Todos foram submetidos à análise tridimensional da marcha antes e após a realização dos procedimentos cirúrgicos, com tempo de seguimento médio de 15,5 meses. Resultados: Houve aumento significativo e semelhante no arco de movimento dos joelhos em ambos os grupos após a realização dos procedimentos cirúrgicos. O aumento do pico de flexão na fase de balanço foi estatisticamente significante apenas no grupo A (aumento de 10,97°), porém foi observado aumento da flexão (de 10,53° para 14,71 °) na fase de apoio no exame pós-operatório. No grupo B foi observada redução da flexão no apoio e aumento do pico de flexão no balanço, porém ambos não significativos em termos estatísticos. Conclusão: Na amostra estudada, houve aumento significativo do arco de movimento dos joelhos após a realização dos procedimentos cirúrgicos, porém o alongamento dos isquiotibiais mediais não gerou aumento adicional.
Assuntos
Humanos , Paralisia Cerebral , Marcha , Articulação do Joelho , Amplitude de Movimento Articular , Estudos RetrospectivosRESUMO
The effects of intramuscular psoas lengthening on gait in cerebral palsy patients have been the subject of debates, and the indications for such procedure are still controversial. The purpose of this study was to evaluate the effects of intramuscular psoas lengthening on sagittal plane pelvic and hip motion in patients with spastic diparetic cerebral palsy and identify the factors linked to the best possible outcome. A retrospective study was performed in 26 independent ambulatory patients. All of them had undergone an intramuscular psoas lengthening over the pelvic brim. The mean age at the time of surgery was 11.10 years, and most cases went through additional simultaneous procedures. A complete gait analysis was performed before and, on average, at 17.69 months (range, 6-39 months) after surgery. The Thomas test values, maximum hip extension in stance, and pelvic tilt were analyzed before and after surgical intervention, and the results were statistically compared. The most significant postoperative effect was the reduction of pelvic range of motion (P < 0.01). Reduction of anterior pelvic tilt was observed only in those patients with no previous need of an external aid (P < 0.01), and the studied group did not show a significant improvement of hip extension at terminal stance. According to the results, intramuscular psoas lengthening was useful in reducing pelvic range of motion at the sagittal plane, but this study also suggests that pelvic and hip disruptions of the same plane (sagittal) seem to have a multifactorial etiology. The use of external assistive devices in patients with balance problems may lead to increased anterior pelvic tilt as well as reduction of hip extension at terminal stance.