| Objective: The patients with Spastic Cerebral Palsy(SCP)may have notable physical abnormality mainly including an impaired mobility and defected appearance of the lower extremities.In the early stage of the disease,children with SCP mainly present with hyperactivity rather than much uncommon muscular contracture.However,with the progression of the condition,deformities including the muscular spasm/contracture and associated hip/knee flexion as well as foot evertion may be observed.A number of optional treatments for SCP are available,including rehabilitation exercise which is essential for the treatment of early SCP,and surgical intervention,which is useful for stabilized deformity not usually responded to the rehabilitation.The surgical intervention for SCP often has a favorable short-term outcome,and may provide a basis for the future therapy such as rehabilitation.Concurrent application of multiple surgical procedures for several individual malformations and deformities in the lower extremities may have advantages such as limited injury,low sufferings and minimized side effects.In addition,the surgical intervention is also characterized by rapid postoperative refreshment,thorough correction of the deformity,improved limb activity and additional correction for the secondary limb deformities.Moreover,a pseudo deformity secondary to the lower limb contracture may appear during the course of the condition due to an unusual posture maintained by the upper extremities that are aimed for the compensation for the body imbalance induced by lower limb deformities.As the lower limb deformities are modified,the pseudo deformities of the upper limbs may be resolved or subside completely.Due to the recovery of normal usage of muscles,the strabismus,torticollis and verbal problems may be resolved accordingly.In the present study,an individualized therapeutic strategy established based on the pathology,age and other features of the patients with SCP was used,in order to evaluate the efficacy of this strategy on the muscular tone,gross motor and the quality of daily life.Methods: A total of 128 patients with SCP-induced lower limb abnormalities(including bilateral abnormalities,n = 120;unilateral abnormality,n = 8;male,n =86;female,n = 42)that were treated in Department of Orthopedics of the Eighth Hospital of Shijiazhuang between December 2014 and May 2015 were enrolled.The patients aged between 3 and 44 years,and had normal mentality.For the patients that can be compliable for the rehabilitation and have localized involvement of the deformities in the extremities were enrolled,a combined selective peripheral neurotomy(SPN)and an individualized surgical intervention according to the features of the patients were used to address the extremity problems;for those that nearly one side of the body or multiple muscles were affected with an increased muscular tone above Grade 2,the selective posterior rhizotomy(SPR)in conjunction with corrective surgery was used.The variables used for the evaluation of the general condition of the patients at Day 3,Week 6 and 6 months after the surgical interventions were Modified Ashworth Scale(MAS),Gross Motor Function Classification System(GMFCS),Activity Daily Living Scale(ADL)and excellence rate of recovery.The data were pooled and analyzed using SPSS 11.0 software to evaluate the overall efficacy.Results:1.The muscular tone of the patients was reduced in a rough stepwise manner beginning from Day 0 to Day 3,Week 6 and Month 6 postoperatively(Day 3 versus Day 0,t=19.030,P <0.01;Month 6 versus Week 6,t=2.087,P =0.037).Of note,no significant difference on the muscular tone between Week 6 and Day 3 postoperatively was found(Week 6 versus Day 3,t=1.014,P =0.311).2.The GMFCS scores of the patients were improved stepwise beginning from Day 0 to Day 3,Week 6 and Month 6 postoperatively(Day 3 versus Day 0,t=15.553,P <0.01;Week 6 versus Day 3,t=12.590,P <0.01;Month 6 versus Week 6,t=3.161,P =0.002).3.As reflected by ADL scores,the daily living skills of the patients were also improved stepwise beginning from Day 0 to Day 3,Week 6 and Month 6 postoperatively(Day 3 versus Day 0,t=2.634,P =0.009;Week 6 versus Day 3,t=7.180,P <0.01;Month 6 versus Week 6,t=5.866,P <0.01).4.The immediately postoperative overall excellence rate was 82.81%,and increased up to 91.41% after two courses of rehabilitation.Conclusion: In this study,the individualized treatment strategy for SCP-induced lower limb abnormalities includes SPR + corrective surgery + rehabilitation and SPN + corrective surgery + rehabilitation.Taking consideration of the global disease,this strategy aims for the practical condition of the different patients,and subsequent concurrent application of multiple surgical procedures for several individual malformations and deformities in the lower extremities may lead to a favorable result.This strategy has the following advantages: to regain the gravity line and improve the balance of the muscular tone;to avoid the deterioration of the muscular and skeleton deformities and to support the rehabilitation.For the patients with SCP-induced lower limb abnormalities,the precise evaluation to select the optimized surgical approach(with appropriate rehabilitations)may contribute to the improvement of muscular tone and gross motor function and the enhancement of the daily life skills,demonstrating that this strategy may have notable efficacy and clinical utility for the condition. |
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