Neuro-orthopedic approach to treatment of contractures in patients with spastic paresis



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The objective of the study was the analysis of possibility of correction of contractures in children with spastic cerebral palsy after combined (neurosurgical and orthopedic) treatment. The total amount of patients was 29 (41 segments). Neurosurgical options included selective neurotomies of the branches of tibial nerve in spastic deformities of the feet in all of the patients were treated (41 procedures respectively). Orthopedic options included tenomyoplastic procedures (Achilles tendon lengthening, gastrocnemius aponeurotic lengthening) in 26 of the patients presenting with accompanying fixed contractures. Preoperative and postoperative investigation included clinical assessment (range of passive and active motion, Ashworth scale assessment) and electroneuromyography. The surgical procedure was performed by intraoperative electrostimulating control. The average postoperative follow-up was 11 months, 20 patients (28 segments) were surveyed. Decrease of the muscle tone was recognized in all of the cases, the average rate of diminishing was 57.5 %. The clonic reaction of foot was diminished or disappeared in 73 % of the cases. Achilles reflex was normalized in all of the patients. Electromyographic data did not reveal any trends. Particular deformation relapse was observed in 19 segments. The analysis of the presented material allows making a conclusion that combined single-event neurosurgical and orthopedic treatment is the method of choice in presence of the high tone and progressive or existing muscular contracture in evidence of inefficiency of conservative treatment in children with cerebral palsy.

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V V Umnov

V M Kenis

Email: kenis@mail.ru

References

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