Skoutelis Vasileios C, Kanellopoulos Anastasios D, Kontogeorgakos Vasileios A, Dinopoulos Argirios, Papagelopoulos Panayiotis J
Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.
Laboratory of Neuromuscular and Cardiovascular Study of Motion, Department of Physiotherapy, School of Health and Care Sciences, University of West Attica, Egaleo, Attica, Greece.
J Orthop. 2020 Nov 4;22:553-558. doi: 10.1016/j.jor.2020.11.002. eCollection 2020 Nov-Dec.
Spastic Cerebral Palsy (CP) is the most common form of CP, comprising of 80% of all cases. Spasticity is a type of hypertonia that clinically manifests as dynamic contractures. The dynamic contracture along with the reduced level of physical activity in a child with CP leads to secondary structural and morphological changes in spastic muscle, causing real musculotendinous shortening, known as fixed contractures. When fixed muscle contractures are not treated early, progressive musculoskeletal deformities develop. As a consequence, spastic CP from a static neurological pathology becomes a progressive orthopaedic pathology which needs to be managed surgically. Orthopaedic surgical management of CP has evolved from previous "multi-event single level" procedures to a "single event multilevel" procedures, with changes in selection and execution of treatment modalities. There is increasing evidence that multilevel surgery is an integral and essential part of therapeutic management of spastic CP, but more research is needed to ensure effectiveness of this intervention on all domains of physical disability in CP.
痉挛型脑瘫（CP）是脑瘫最常见的类型，占所有病例的80%。痉挛是一种张力亢进，临床上表现为动态挛缩。动态挛缩以及CP患儿身体活动水平降低会导致痉挛肌肉发生继发性结构和形态变化，引起真正的肌腱缩短，即固定性挛缩。如果固定性肌肉挛缩不及早治疗，就会发展为进行性肌肉骨骼畸形。因此，痉挛型脑瘫从一种静态神经病理学疾病转变为一种需要手术治疗的进行性骨科疾病。CP的骨科手术治疗已从以前的“多阶段单平面”手术发展为“单阶段多平面”手术，治疗方式的选择和实施也有所变化。越来越多的证据表明，多平面手术是痉挛型CP治疗管理不可或缺的重要组成部分，但还需要更多研究来确保这种干预对CP身体残疾所有方面的有效性。
