Thamkunanon Verasak
Department of Orthopedics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
J Med Assoc Thai. 2011 Aug;94 Suppl 3:S183-8.
Single Event Multilevel soft tissue surgery in spastic diplegic children also was effective for improving ambulatory function obviously as multilevel bone and soft tissue surgery. Just muscle and tendon surgery seem to be enough for better lever arm dysfunction of the lower extremity. It has safe, simple and rapid recovery.
Gross Motor Functional Classification System (GMFCS) improvement after single event multilevel soft tissue surgery had been observed in these study groups of patients.
Retrospective review in 93 spastic diplegic children who were more than 3 years old, had ability to understand communication, at least leaned sitting and one-hand gross function ability had been operated on by single event multilevel soft tissue surgery. GMFCS was assessed at the time of pre-operation and 6-12 months after operation. Analyzing GMFCS change was performed by statistics.
Average 7 site surgery per one patient, 84% GMFCS level improvement and 16% GMFCS level non-improvement were reported. Nine cases (9.7%) were improved 2 level of GMFCS and 74% improved 1 level. GMFCS level compared between pre- and post surgery had changed by the significant statistic (p < 0.001). The average GMFCS level improvement for all groups was 0.93 level. The average age in the improved group (75 months old) was less than the non-improved group (92 month old), was a trend difference in statistic (p = 0.032).
Single Event Multilevel Soft tissue surgery was effective in improving the GMFCS level average 1 level. It changed ambulatory function of spastic diplegic CP children obviously, immediately and safely. Younger age might get more benefit than older children.
对于痉挛性双侧瘫患儿,单阶段多水平软组织手术在改善步行功能方面与多水平骨与软组织手术同样有效。仅肌肉和肌腱手术似乎就足以改善下肢杠杆臂功能障碍。该手术具有安全、简单且恢复迅速的特点。
在这些患者研究组中观察单阶段多水平软组织手术后粗大运动功能分类系统(GMFCS)的改善情况。
对93例3岁以上、有沟通理解能力、至少具备独坐和单手粗大功能能力且接受了单阶段多水平软组织手术的痉挛性双侧瘫患儿进行回顾性研究。在术前及术后6 - 12个月评估GMFCS。通过统计学方法分析GMFCS的变化。
报告显示,每位患者平均进行7个部位的手术,GMFCS水平改善的占84%,未改善的占16%。9例(9.7%)GMFCS水平提高了2级,74%提高了1级。术前与术后GMFCS水平比较有显著统计学差异(p < 0.001)。所有组GMFCS水平平均提高0.93级。改善组的平均年龄(75个月)小于未改善组(92个月),存在统计学趋势差异(p = 0.032)。
单阶段多水平软组织手术能有效使GMFCS水平平均提高1级。它能明显、即刻且安全地改变痉挛性双侧瘫脑瘫患儿的步行功能。年龄较小的患儿可能比年龄较大的患儿获益更多。