AbstractBackground and aims
Deformity of foot in children with cerebral palsy is the most common orthopaedic pathology of the lower extremities, occurring in more than 95% of patients. Improving the efficiency of surgical treatment of foot deformities in children with spastic forms of cerebral palsy.Methods
We analysed the results of surgical correction of feet deformities of 160 patients (247 feet) with spastic forms of cerebral palsy with a mean age of 7.4 years (2–17 years) who were treated in the Department of Neuroorthopaedic and Orthopaedic Surgery of ‘NSPCCH’ between 2008 and 2016. In the group 1 (2008–2013) surgical interventions were performing based on principles of the ’classic’ orthopaedic surgery (60 patients)- on soft tissue structures of the foot (160 operative procedures, 118 operations). The main criteria were clinical and radiological picture. The group 2 (2014–2016 — 100 patients, 184 operative procedures, 140 operations): surgical corrections were performed with using a ’Neuroorthopaedic’ concept. It was based on the potential of habilitation a child with cerebral palsy. Criteria of a choice of tactics of treatment: the nature and severity of deformity, its components, age, the form of the underlying disease, the level in GMFCS, the potential of the walk, the pattern of spasticity, motor stereotype A. Ferrari, level of intelligence, results of radiological methods of investigation. Patients in both groups were the same age, GMFCS level, severity of the deformity. The rehabilitation was carried out in the postoperative period.Results
Rating on a scale of AOFAS from 3 months to 8 years. Excellent result (90–100 points) in group 1 — 26,6% (16 patients), good (70–90 points) and 55% (33), satisfactory (score 50–70) —10% (6); 2nd: excellent — 51% (51) good — 39% (39) satisfactory — 4% (4). The recurrence rate was 8.3% (5 patients) in 1 group; in the 2nd — 6% (6 patients). In the 2nd group also noted a decrease the timing and amount of periods of postoperative rehabilitation, operative procedures.Conclusions
Neuroorthopaedic concept for surgical treatment of foot deformities is optimal in children with spastic forms of cerebral palsy and allows to achieve the maximum possible motor activity in patients in a shorter time, reducing the number of relapses.