Factors affecting GDI improvement after single event multilevel surgery in patients with cerebral palsy

被引:5
作者
Min, Jae Jung [1 ]
Kwon, Soon-Sun [2 ]
Sung, Ki Hyuk [1 ]
Lee, Kyoung Min [1 ]
Chung, Chin Youb [1 ]
Park, Moon Seok [1 ]
机构
[1] Seoul Natl Univ, Dept Orthopaed Surg, Bundang Hosp, 82 Gumi Ro 173 Beon Gil, Sungnam 13620, Gyeonggi, South Korea
[2] Ajou Univ, Dept Math AI & Data Sci, Coll Nat Sci, Gyeonggi, South Korea
基金
新加坡国家研究基金会;
关键词
Cerebral palsy; SEMLS; GDI; GMFCS; GAIT; KINEMATICS; OSTEOTOMY; CHILDREN;
D O I
10.1016/j.gaitpost.2020.05.033
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Background: Pathologic gait is common in patients with cerebral palsy (CP). Single-event multilevel surgery (SEMLS) is a combination of surgical procedures to improve pathologic gait in patients with CP. However, the effect of each procedure is difficult to predict. The gait deviation index (GDI) is useful in comparing pre- and postoperative improvement. Research question: In this study, we evaluated the degree of GDI improvement in patients with CP and analyzed factors related to surgical outcomes. Methods: We screened patients seen between May 2003 and December 2019 via a clinical data warehouse to identify those with CP who had been followed up for> 1 year and who had undergone SEMLS. The inclusion criteria were (1) CP patients with GMFCS levels I, II and III, (2) patients who underwent SEMLS, (3) and patients who underwent 3D gait analyses preoperatively and at least 1 year postoperatively. A linear mixed model was used to model GDI improvement, assess effects of covariates, and examine factors that contributed to improvement. Results: Overall, 544 patients were included. The average improvement in overall GDI was 8.9 +/- 12.3, 9.6 +/- 12.0, and 6.4 +/- 8.6 in Gross Motor Function Classification System (GMFCS) levels I, II, and III, respectively. In GMFCS level II patients, GDI improvement decreased by 0.26 points with a 1-year delay in surgery (p = 0.0022). Within each group of GMFCS levels, femoral derotation osteotomy (FDO) was a significant factor in GDI improvement in GMFCS levels I and II. Rectus femoris transfer (RFT) and supracondylar extension osteotomy (SCO) were significant factors in GMFCS level II. No single procedure was shown to affect improvement in GMFCS level III. Significance: Postoperative GDI improved in all levels of GMFCS. Particular procedures especially affected postoperative improvement in GDI in levels I and II. Our data do not mean to set an indication for particular procedures; however, in GMFCS levels I, II patients, particular procedures, such as FDO, yielded a greater GDI improvement in our data set.
引用
收藏
页码:101 / 105
页数:5
相关论文
共 50 条
[41]   Multilevel surgery in adults with cerebral palsy [J].
Putz, C. ;
Doederlein, L. ;
Mertens, E. M. ;
Wolf, S. I. ;
Gantz, S. ;
Braatz, F. ;
Dreher, T. .
BONE & JOINT JOURNAL, 2016, 98B (02) :282-288
[42]   Evaluation of factors affecting external tibial torsion in patients with cerebral palsy [J].
Min, Jae Jung ;
Kwon, Soon-Sun ;
Kim, Kyu Tae ;
Choi, Young ;
Sung, Ki Hyuk ;
Lee, Kyoung Min ;
Park, Moon Seok .
BMC MUSCULOSKELETAL DISORDERS, 2021, 22 (01)
[43]   Long-term results of multilevel surgery in adults with cerebral palsy [J].
Putz, Cornelia ;
Blessing, Ann-Kathrin ;
Erhard, Sarah ;
Fiethen, Katharina ;
Geisbuesch, Andreas ;
Niklasch, Mirjam ;
Doederlein, Leonhard ;
Wolf, Sebastian Immanuel ;
Dreher, Thomas .
INTERNATIONAL ORTHOPAEDICS, 2019, 43 (02) :255-260
[44]   Tibial rotation outcomes following hamstring lengthening as part of single event multilevel surgery in children with cerebral palsy [J].
Marron, A. ;
O'Sullivan, R. ;
Kelly, E. ;
Kiernan, D. .
GAIT & POSTURE, 2020, 79 :126-132
[45]   Comparison of single event multilevel surgery and multiple surgical events in the lower extremities of children with spastic cerebral palsy [J].
Aslan, Ahmet ;
Diril, Sabri Kerem ;
Demirci, Demir ;
Yorgancigil, Huseyin .
EKLEM HASTALIKLARI VE CERRAHISI-JOINT DISEASES AND RELATED SURGERY, 2019, 30 (03) :217-223
[46]   Evaluation of single event multilevel surgery and rehabilitation in children and youth with cerebral palsy - A 2-year follow-up study [J].
Akerstedt, Anita ;
Risto, Olof ;
Odman, Pia ;
Oberg, Birgitta .
DISABILITY AND REHABILITATION, 2010, 32 (07) :530-539
[47]   Rectus femoris transfer in multilevel surgery: Technical details and gait outcome assessment in cerebral palsy patients [J].
Khouri, N. ;
Desailly, E. .
ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, 2013, 99 (03) :333-340
[48]   Assessment of gait quality and efficiency after undergoing a single-event multilevel surgery in children with cerebral palsy presenting an intoeing gait pattern [J].
Gabriel Moisan ;
Alice Bonnefoy-Mazure ;
Géraldo De Coulon ;
Anne Tabard-Fougère ;
Stéphane Armand ;
Katia Turcot .
Child's Nervous System, 2022, 38 :1523-1530
[49]   Assessment of gait quality and efficiency after undergoing a single-event multilevel surgery in children with cerebral palsy presenting an intoeing gait pattern [J].
Moisan, Gabriel ;
Bonnefoy-Mazure, Alice ;
De Coulon, Geraldo ;
Tabard-Fougere, Anne ;
Armand, Stephane ;
Turcot, Katia .
CHILDS NERVOUS SYSTEM, 2022, 38 (08) :1523-1530
[50]   Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors [J].
Samdani, Amer F. ;
Belin, Eric J. ;
Bennett, James T. ;
Miyanji, Firoz ;
Pahys, Joshua M. ;
Shah, Suken A. ;
Newton, Peter O. ;
Betz, Randal R. ;
Cahill, Patrick J. ;
Sponseller, Paul D. .
EUROPEAN SPINE JOURNAL, 2016, 25 (03) :795-800