Park Moon Seok, Chung Chin Youb, Lee Sang Hyeong, Choi In Ho, Cho Tae-Joon, Yoo Won Joon, Lee Kyoung Min
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Bundang-Gu, Sungnam, Kyungki, Korea.
J Pediatr Orthop. 2009 Oct-Nov;29(7):765-70. doi: 10.1097/BPO.0b013e3181b529e8.
This study was performed to identify issues of concern to parents after single-event multilevel surgery in ambulatory patients with cerebral palsy.
Parents' reports of concern were obtained for 72 ambulatory patients with hemiplegic cerebral palsy (group H; mean age 8.7 y) and 170 ambulatory patients with diplegia (group D; mean age 8.9 y), who had undergone single-event multilevel surgery and were followed for more than 1 year (mean follow-up 5.5 y). Data were acquired using a postal survey. Issues of concern to parents were evaluated using a 5-point Likert scale (1 to 5) for each of 33 items, which was designed for this study.
The top 3 issues of concern after surgery were unequal limb circumference, the operative scar, and recurrence in group H, and the operative scar, play activity, and recurrence in group D. Overall concerns were greater in group D (P=0.001) whereas group H was more concerned about appearance such as unequal leg length and circumference (P=0.001, <0.001). The issue of concern that showed the best correlation with parental satisfaction was the insufficient rehabilitation in group H (r=-0.457, P<0.001) and the improvement in walking ability in group D (r=-0.552, P<0.001).
Even though parental concern over insufficient rehabilitation and improvement in walking ability showed the best correlation with parental satisfaction, related issues such as unequal leg circumference and surgical scar scored high, which appear irrelevant to the purpose of the surgical procedures. Parents' understanding should be established regarding surgical outcomes and limitations before single-event multilevel surgery. Clinicians need to pay more attention to potentially treatable issues that cause concern to parents, such as operative scars.
Diagnostic level 3.
本研究旨在确定脑性瘫痪门诊患者接受单阶段多水平手术后家长关心的问题。
获取了72例偏瘫型脑性瘫痪门诊患者（H组；平均年龄8.7岁）和170例双瘫门诊患者（D组；平均年龄8.9岁）家长关心问题的报告，这些患者均接受了单阶段多水平手术，且随访时间超过1年（平均随访5.5年）。通过邮寄调查问卷收集数据。使用为本研究设计的33个项目的5级李克特量表（1至5）对家长关心的问题进行评估。
术后最受关注的3个问题在H组为肢体周径不等、手术瘢痕和复发，在D组为手术瘢痕、玩耍活动和复发。总体而言，D组的担忧程度更高（P = 0.001），而H组更关注外观，如腿长和周径不等（P = 0.001，<0.001）。与家长满意度相关性最好的关注问题在H组是康复不足（r = -0.457，P < 0.001），在D组是步行能力改善（r = -0.552，P < 0.001）。
尽管家长对康复不足和步行能力改善的担忧与家长满意度相关性最好，但腿周径不等和手术瘢痕等相关问题得分较高，而这些问题似乎与手术目的无关。在进行单阶段多水平手术前，应让家长了解手术结果和局限性。临床医生需要更加关注引起家长担忧的潜在可治疗问题，如手术瘢痕。
诊断性3级。
