Wild Dana L, Stegink-Jansen Caroline W, Baker Christine P, Carmichael Kelly D, Yngve David A
Department of Physical Therapy, The University of Texas Medical Branch, Galveston, TX, USA.
Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
Minim Invasive Surg. 2020 Aug 19;2020:5124952. doi: 10.1155/2020/5124952. eCollection 2020.
Improvements in surgical and rehabilitation care are critical to lessen the burden of cerebral palsy (CP), the most common cause of severe physical disability in childhood. The selective percutaneous myofascial lengthening (SPML) surgical procedure is a minimally invasive method designed to improve ambulation by lengthening contracted musculoskeletal tissues. Information on surgical procedures, efficacy, and safety of SPML for children with CP is lacking. Phase 1 of our research is a "proof-of-principle" study for multisite SPML to improve functional mobility of children with CP, and Phase 2 assesses safety, reoperation rates, and efficacy over time in subsequent patient series. Phase 1 was a repeated measurement case series study of 17 children (mean age 7.6 years). One physical therapist, blinded to the surgeon's measurements, measured bilateral knee and ankle motion before and after SPML procedures, using video recordings of a standardized gait path. Functional Mobility Scale (FMS) 5, 50, and 500 outcomes were taken pre- and postoperatively and via telephone follow-up. In Phase 2, multisite SPLM surgeries were implemented in larger successive cohorts from 2006 to 2017. Complications, reoperation rates, and efficacy were retrospectively analyzed. Phase 1 results showed improvement in the children's knee and ankle motion while ambulating and improved FMS 5, 50, and 500 outcomes postoperatively (mean, 6.3 months). At second follow-up (mean 33.3 months), FMS 500 scores continued improvement, while FMS 5 and FMS 50 scores maintained. During Phase 2, the complication rate was 2.4%, and reoperation rates (including reoperations due to maturation) were between 8% and 13%. Improvements to correct ankle equinus were recorded in 498 cases. In conclusion, in a specialized center, single-event, multilevel SPML surgeries of children with CP safely improved ambulatory knee and ankle angle motion and daily mobility outcomes. Future educational studies of training needs for surgeons new to the approach are needed.
手术和康复护理的改善对于减轻脑瘫（CP）负担至关重要，脑瘫是儿童严重身体残疾的最常见原因。选择性经皮肌筋膜延长术（SPML）是一种微创手术方法，旨在通过延长挛缩的肌肉骨骼组织来改善步行能力。目前缺乏关于SPML手术对CP患儿的手术过程、疗效和安全性的信息。我们研究的第一阶段是一项多中心SPML的“原理验证”研究，以改善CP患儿的功能活动能力，第二阶段评估后续患者系列中随时间推移的安全性、再次手术率和疗效。第一阶段是对17名儿童（平均年龄7.6岁）进行的重复测量病例系列研究。一名对手术医生测量结果不知情的物理治疗师，使用标准化步态路径的视频记录，在SPML手术前后测量双侧膝关节和踝关节的活动度。术前、术后以及通过电话随访获取功能活动量表（FMS）5、50和500的结果。在第二阶段，2006年至2017年在更大的连续队列中实施了多中心SPLM手术。对并发症、再次手术率和疗效进行了回顾性分析。第一阶段结果显示，患儿在行走时膝关节和踝关节活动度有所改善，术后FMS 5、50和500结果有所改善（平均6.3个月）。在第二次随访时（平均33.3个月），FMS 500评分持续改善，而FMS 5和FMS 50评分保持稳定。在第二阶段，并发症发生率为2.4%，再次手术率（包括因发育成熟导致的再次手术）在8%至13%之间。记录到498例纠正马蹄足内翻的改善情况。总之，在一个专业中心，对CP患儿进行单事件、多节段SPML手术可安全地改善步行时膝关节和踝关节角度活动度以及日常活动能力结果。未来需要针对该方法的新手外科医生的培训需求进行教育研究。
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