Gazi ZORER, Cemal DOĞRUL, Mehmet ALBAYRAK, A. Erdem BAGATUR

Spastik serebral palsili haataların alt ekstremitelerinde tek aşamalı çok seviyeli kas-tendon cerrahisi sonuçları

Amaç: Spastik serebral palsili hastaların alt ekstremitelerinde gelişmiş olan kontraktürlerin tedavisinde uygulanan tek aşamalı çok seviyeli kas-tendon cerrahisinin sonuçları değerlendirildi. Çalışma planı: Spastisite nedeniyle alt ekstremitelerde gelişmiş olan kontraktürlerin tedavisi için tek aşamalı çok seviyeli kas-tendon cerrahisi uygulanan serebral palsili 23 hastanın (11 kız, 12 erkek; ort. yaş 6 yıl 3 ay; dağılım 4-17 yıl) ameliyat öncesi ve sonrası (ort. 4 yıl 9 ay; dağılım 1-8 yıl) fizik muayene bulguları ve Gross Motor Function Classification System (GMFCS) (Kaba Motor Fonksiyon Sınıflama Sistemi) sonuçları değerlendirildi. Hastaların beşi kuadriplejik, 14'ü diplejik, dördü hemiplejikti. Ameliyat öncesi dönemde 13 hasta yürürken, 10 hasta destekli ya da desteksiz yürüyemiyordu. Son kontroller sırasında hastaların ortalama yaşı 11.5 (dağılım 9-19) idi. Sonuçlar: Tüm eklemlerde hareket açıklığının ameliyat öncesi döneme göre arttığı ve bunun hastanın postür, oturma, yürüme ve beden temizliği üzerinde belirgin iyileşme sağladığı görüldü. Yürüyemeyen 10 hastanın beşi ameliyat sonrasında yürüteç ya da koltuk değneği ile yürüyordu. Ameliyat öncesi dönemde 3.045 olan GMFCS ortalaması, ameliyat sonrası dönemde 1.864 bulundu (p

Anahtar Kelimeler:

Biyomekanik, Kontraktür, Çocuk, Hareket açıklığı, eklem, Yürüyüş şekli, Beyin felci, Kas spastisitesi

The results of single-stage multilevel muscle-tendon surgery in the lower extremities of patients with spastic cerebral palsy

Objectives: We evaluated the results of single-stage multilevel muscle-tendon surgery performed for the treatment of contractures in the lower extremities of patients with spastic cerebral palsy. Methods: The study included 23 patients (11 girls, 12 boys; mean age 6 years 3 months; range 4 to 17 years) with spastic cerebral palsy, who underwent single-stage multilevel muscle-tendon surgery for the treatment of contractures in the lower extremities secondary to spasticity. Quadriplegia, diplegia, and hemiplegia were present in five, 14, and four patients, respectively. Preoperatively, 13 patients could walk, while 10 patients lacked ambulation even with support. Evaluations were based on pre- and postoperative (mean 4 years 9 months; range 1 to 8 years) physical examination findings and on the Gross Motor Function Classification System (GMFCS) scores. The patients’ mean age at the last follow-up was 11.5 years (range 9 to 19 years). Results: The range of motion of all the operated joints improved postoperatively, resulting in significant improvements in posture, sitting, gait, and hygiene of the patients. Of ten patients who could not walk, five could ambulate with the use of a walker or crutches postoperatively. The mean pre- and postoperative GMFCS scores were 3.045 and 1.864, respectively (p<0.001). All patients showed an improvement of at least one GMFCS level. Conclusion: Surgery for spastic cerebral palsy can be most beneficial only when all contractures of the hip, knee, and ankle have been corrected. Symmetrical and multilevel operations should be performed when necessary, for single-stage and symmetrical multilevel muscle-tendon surgical applications have definite advantages over staged interventions.

Keywords:

Biomechanics, Contracture, Child, Range of Motion, Articular, Gait, Cerebral Palsy, Muscle Spasticity,

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