Effects of orthopedic intervention in adolescents and young adults with cerebral palsy.

摘要

The purpose of this study was to determine the effects of orthopedic procedures performed after skeletal maturity on ambulatory patients with cerebral palsy. Twenty-five patients (46 sides) had pre- and postoperative computerized gait analysis. All patients underwent any one or a combination of the following procedures: hamstring lengthenings, ankle plantar flexor lengthenings, rectus femoris transfers, psoas lengthenings, and femoral derotation osteotomies. Surgical results were similar in this group of older patients to those for younger individuals with cerebral palsy. Surgical procedures were evaluated pre- versus postoperatively within the subgroups of patients that had a particular procedure. Patients experienced the following results 1 year postoperatively: (1) improved knee extension at initial contact following hamstring lengthenings (n=35 sides, preop=32+/-15 degrees, postop=22+/-13 degrees, p<0.01), (2) improved peak dorsiflexion in swing (n=23 sides, preop=-1+/-9 degrees, postop=6+/-8 degrees, p<0.01) and improved modulation with peak dorsiflexion occurring later in stance (preop=31+/-15% of gait cycle, postop=43+/-13% of gait cycle, p<0.01) following ankle plantar flexor lengthenings, (3) improved hip rotation following femoral derotational osteotomies (n=9 sides, preop=19+/-12 degrees internal, postop=0+/-12 degrees, p<0.01), (4) improved peak knee flexion in swing following rectus femoris transfers (n=23 sides, preop=47+/-11 degrees, postop=55+/-13 degrees, p=0.01), (5) a reduction in excessive hip flexion during terminal stance was found in those patients with psoas lengthening (n=8 sides, preop=18+/-21 degrees, postop=9+/-19 degrees, p=0.04).