EFFECTIVENESS OF TENDON-MUSCLE PLASTY OF THE KNEE JOINT IN PATIENTS HAVING SPASTIC CEREBRAL PALSY WITH FLEXION CONTRACTURES OF KNEE JOINTS



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Introduction. Cerebral palsy (CP) is the main cause of childhood neurological disability in the world. Due to the fact that the prevalence of knee contractures in children with cerebral palsy occupies the 3rd place in the structure of orthopedic pathology of the lower extremities, this topic is least covered in the scientific periodicals. Material and methods. Findings from 40 patients of the main group, aged 7-12 and having cerebral palsy (CP), were studied retrospectively. They had knee flexion contractures with patella alta. Findings of goniometry and of Gillette FAQ were analyzed before and after surgery. The Spearman coefficient was used for the correlation analysis of goniometry parameters and surgical intervention effectiveness before surgery. 35 patients having no bilateral CP damage and other diseases leading to lower limb deformities were included into the reference group. X-ray examination and goniometry assessment of a healthy limb were made in patient’s lying position on his back with passive extension; plus goniometry in a standing position with shin active extension. Results. The median of deformation angles before and after surgery was 20° and 5°, respectively (p <0.05). Correction volume was 80%. The median of scores by the Gillette increased from 2 to 3 (p <0.05) after surgery. Assessment of the correlation between preoperative goniometry values and treatment efficacy values showed a significant moderate feedback (p <0.05). Conclusion. The stronger the deformity before surgery, the less chance for developing the standing-up function. The best result can be achieved when deformity is 10-25°. Normal values of passive extension by goniometry in a healthy knee for children aged 7-12 in a lying position are 6 ° hyper-extension (genu recurvatum) (± 2 °) and 12 ° hyper-extension (±3°) of a knee joint by lateral X-ray. Normal active extension in children aged 7-12 in a standing position is 3° hyper-extension (±2°). Smaller values of the tibiofemoral angle by goniometry in a standing position and maximun values for passive extension by X-ray and goniometry assessment may serve as clinical and radiological criteria of knee flexion contracture.

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M. Volkova

National Medical Research Center for Children’s Health (NCZD)

编辑信件的主要联系方式.
Email: volkova-mo@mail.ru
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K. Zherdev

National Medical Research Center for Children’s Health (NCZD)

Email: noemail@neicon.ru
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O. Chelpachenko

National Medical Research Center for Children’s Health (NCZD)

Email: noemail@neicon.ru
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S. Yatsyk

National Medical Research Center for Children’s Health (NCZD)

Email: noemail@neicon.ru
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参考

  1. Sharan D. Orthopedic surgery in cerebral palsy: Instructional course lecture. Indian journal of orthopaedics. 2017; 51(3): 240.
  2. MacWilliams B.A., Harjinder B., Stevens P.M. Guided growth for correction of knee flexion deformity: a series of four cases. Strat Traum Limb Recon. 2011; 6:83-90.
  3. Умнов В.В. Основные подходы к устранению сгибательной контрактуры коленного сустава у больных ДЦП. Травматология и ортопедия России. 2013; 3 (69): 119-24.
  4. Умнов В.В., Звозиль А.В., Умнов Д.В., Новиков В.А. Взаимосвязь сгибательных контрактур в суставах нижних конечностей и сагиттального профиля позвоночника у больных детским церебральным параличом: предварительное сообщение. Ортопедия, травматология и восстановительная хирургия детского возраста. 2016; (4): 71-6.
  5. Спивак, Е. М. Диагностика синдрома гипермобильности суставов в детском возрасте. Вестник Ивановской медицинской академии. 2009; 14 (4): 28-30.
  6. Маркс В.О. Ортопедическая диагностика: Руководство-справочник. Минск: Наука и техника; 1978.
  7. Klatt J., Stevens P.M. Guided growth for fixed knee flexion deformity. J Pediatr Orthop. 2008;28:626-31. doi: 10.1097/BPO.0b013e318183d573
  8. Трофимова С.И., Буклаев Д.С., Петрова Е.В., Мулеванова С.А. Использование метода управляемого роста для устранения сгибательной контрактуры коленного сустава у пациентов с артрогрипозом: предварительные результаты. Ортопедия, травматология и восстановительная хирургия детского возраста. 2016; 4(4): 64-70
  9. İnan M., Sarikaya İ.A., Yildirim E., Güven M.F. Neurological complications after supracondylar femoral osteotomy in cerebral palsy. J Pediatr Orthop. 2015; 35(3): 290-5.
  10. Stout J.L., Gage J.R., Schwartz M.H., Novacheck T.F. Distal Femoral Extension Osteotomy and Patellar Tendon Advancement to Treat Persistent Crouch Gait in Cerebral Palsy. The Journal of Bone and Joint Surgery-American. 2008; 90(11): 2470-84.
  11. Sossai R., Vavken, P., Brunner R., Camathias C., Graham H.K., Rutz E. Patellar tendon shortening for flexed knee gait in spastic diplegia. Gait & Posture. 2015; 41(2): 658-65.
  12. Salami, F., Brosa, J., Van Drongelen, S., Klotz, M. C., Dreher, T., Wolf, S. I., Thielen, M. “Long term muscle changes after hamstring lengthening in children with bilateral cerebral palsy.” Developmental Medicine & Child Neurology. 2019; 61(7): 791-7.
  13. Aiona, M., Do, K. P., Feng, J., & Jabur, M. Comparison of rectus femoris transfer surgery done concomitant with hamstring lengthening or delayed in patients with cerebral palsy. Journal of Pediatric Orthopaedics. 2017; 37(2):107-10.
  14. Gulenc, B., Kuchimov, S., & Temelli, Y. Clinical and gait analysis of isolated soft tissue release surgery in crouch gait patients. Annals of Medical Research. 2019; 26(8), 1600-4.
  15. Galli M., Cimolin V., Vimercati S., Albertini G., Brunner R. Quantification of patellar tendon shortening in a patient with cerebral palsy. Journal of applied biomaterials & functional materials. 2014; 12(1): 57-63.
  16. Киселевский, Ю.М., Иванцов А.В. Структурно-функциональные особенности коленного сустава. Журнал Гродненского государственного медицинского университета. 2008; 1(21): 109-12.
  17. Жердев К.В., Пак Л. А., Волкова М. О., Зубков П. А., Челпаченко О. Б. Актуальные направления оптимизации хирургического лечения опорно-двигательных нарушений при спастических формах детского церебрального паралича. Российский педиатрический журнал. 2018; 21(3): 175-81.
  18. Букуп К. Букуп Й. Клиническое исследование костей, суставов и мышц. М.: Медицинская литература; 2018.
  19. Rejeb A, Fourchet F., Materne O., Johnson A., Horobeanu C., Farooq A., et al. Beighton scoring of joint laxity and injury incidence in Middle Eastern male youth athletes: a cohort study. BMJ Open Sport Exerc Med. 2019; 5: e000482. doi: 10.1136/bmjsem-2018-000482

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