Jain Shweta, Mathur Navnendra, Joshi Mrinal, Jindal Rajeshwari, Goenka Sunil
Department of Physical Medicine and Rehabilitation, SMS Hospital, SMS Medical College, Jaipur, Rajasthan, India.
Indian J Pediatr. 2008 Oct;75(10):997-1002. doi: 10.1007/s12098-008-0100-z. Epub 2008 Jun 23.
Cerebral palsy (CP) is a range of non progressive syndromes of posture and motor impairment due to an insult to developing brain. Spasticity and incoordination are major causes of disability in these children which can be managed by different modalities like casting, botulinum toxin, surgery etc. Cast application in spastic equinus is a well established procedure in CP but cast application in patients of CP with bilateral involvement of hip, knee and ankle is not document.
A study was conducted on 22 children of spastic CP in age range of 3-8 years with bilateral involvement of hip, knee and ankle in 20 cases, hip and ankle in one case and only ankle in one case. Sixty eight % children were spastic diplegics. Serial weekly cast with (11 cases) or without abductor bar (11 cases) was applied for four weeks. They were followed up variably with an average period of 7 months.
Significant improvement was noticed in range of motion around hip, knee and ankle which as maintained over hip and knee after average follow up. Spasticity was also reduced as measured by Modified Ashworth Scale (MAS). This ultimately improved the ambulatory status and functional ability of these children.
Thus serial casting is a very simple, safe and cost effective procedure which can be applied even in children with mental sub normality having all three major joints involved bilaterally.
脑性瘫痪（CP）是由于发育中的大脑受到损伤而导致的一系列非进行性姿势和运动障碍综合征。痉挛和不协调是这些儿童致残的主要原因，可通过不同方式进行治疗，如石膏固定、肉毒杆菌毒素、手术等。在痉挛性马蹄足中应用石膏固定在脑性瘫痪中是一种成熟的方法，但在双侧髋、膝和踝关节受累的脑性瘫痪患者中应用石膏固定的情况尚无文献记载。
对22例年龄在3至8岁的痉挛性脑性瘫痪儿童进行了研究，其中20例双侧髋、膝和踝关节受累，1例髋和踝关节受累，1例仅踝关节受累。68%的儿童为痉挛性双侧瘫。对11例使用外展杆、11例不使用外展杆的患儿连续每周进行4周的石膏固定。对他们进行了不同时间长度的随访，平均随访期为7个月。
髋、膝和踝关节周围的活动范围有显著改善，平均随访后在髋和膝部得以维持。通过改良Ashworth量表（MAS）测量，痉挛也有所减轻。这最终改善了这些儿童的行走状态和功能能力。
因此，连续石膏固定是一种非常简单、安全且经济有效的方法，即使在双侧累及所有三个主要关节的智力发育迟缓儿童中也可应用。
