Abstract

Introduction Improving the quality of care has led to an increase in the life expectancy of patients with cerebral palsy and in the number of adult patients suffering from cerebral palsy. However, functional motor limitations aggravate after their physiological growth completion and the risk of pain increases. The aim of this work was to study the literature on the problem of surgical orthopedic treatment in adolescents and adults with cerebral palsy belonging to GMFCS levels I-IV of motor disorders as well as to make a preliminary analysis of the surgical orthopedic treatment performed in this category of patients at our institution. Materials and methods The results of multi-level single-event interventions were studied in 165 patients older than 16 years. The sample for analysis included cases that met the following criteria: age of 16 years and older, spastic types of cerebral palsy, GMFCS levels I–IV. In addition, some patients underwent botulinum therapy during the stages of surgical treatment. Results The maximum functional effect was manifested 12–24 months after the surgery if proper early and subsequent rehabilitation was provided. According to the Gillette Functional Assessment Questionaire, motor abilities improved in 81.3 %. Multilevel interventions included 2.3–3.5 elements on average during one surgical session. Current literature postulates the implementation of multi-level single-event interventions and indications for surgery and follow-up control are studied at a motion analysis laboratory. Conclusion Multi-level orthopedic interventions are indicated for patients who have completed physiological growth. Techniques of such interventions should provide early functional activity. Surgical orthopedic treatment in adult patients with cerebral palsy should be performed by the staff and at an institution that specialize in neuro-orthopedics

Highlights

  • Improving the quality of care has led to an increase in the life expectancy of patients with cerebral palsy and in the number of adult patients suffering from cerebral palsy

  • Multi-level orthopedic interventions are indicated for patients who have completed physiological growth

  • Assessment of absolute knee joint linear and angular velocity in patients with spastic cerebral palsy after operative treatment of lever arm dysfunction deformities – prospective study // Chir

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Summary

Федеральное государственное бюджетное учреждение

«Российский научный центр "Восстановительная травматология и ортопедия" им. акад. Г.А. Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russian Federation. Улучшение качества оказания медицинской помощи привело к увеличению продолжительности жизни пациентов с ДЦП и повышению числа взрослых больных, страдающих церебральным параличом. Изучены результаты многоуровневых одномоментных вмешательств у 165 пациентов старше 16 лет. В выборку для анализа вошли случаи, отвечающие следующим критериям: возраст 16 и старше лет, спастические формы ДЦП, уровни I–IV по классификации GMFCS. Части пациентам проводилась ботулинотерапия на этапах хирургического лечения. При выполнении многоуровневых вмешательств одна операция включала, в среднем, 2,3–3,5 элемента. В современной литературе постулируется выполнение многоуровневых одномоментных вмешательств, где показания к хирургии и последующий контроль осуществляются с помощью лаборатории анализа движений. Выполнение многоуровневых ортопедических вмешательств обосновано у пациентов, закончивших физиологический рост. Выполнение ортопедического хирургического лечения взрослым пациентам с церебральным параличом должно проводиться персоналом и в учреждении, специализированном в нейроортопедии. Ключевые слова: детский церебральный паралич, взрослые, многоуровневые ортопедические вмешательства, ботулинотерапия

Introduction
Results
МАТЕРИАЛЫ И МЕТОДЫ
До лечения
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