Single event multilevel surgery in spastic patient : a Hospital Tengku Ampuan Afzan (HTAA) experience
INTRODUCTION: Single event multilevel surgery (SEMLS) is common procedure to improve gait and functioning of children with spastic cerebral palsy(CP).These series is aim to observe post-operative outcomes of gross motor function (GMFCS) and hip migration index (MI). MATERIALS & METHODS:...
| Main Authors: | , , , |
|---|---|
| Format: | Proceeding Paper |
| Language: | English English |
| Published: |
2020
|
| Subjects: | |
| Online Access: | http://irep.iium.edu.my/78831/ http://irep.iium.edu.my/78831/30/78831program%20book%20and%20certificate.pdf http://irep.iium.edu.my/78831/4/SEMLS%20poster%20for%20SPOS.pdf |
| Summary: | INTRODUCTION:
Single event multilevel surgery (SEMLS) is common procedure to improve gait and functioning of children with spastic cerebral palsy(CP).These series is aim to observe post-operative outcomes of gross motor function (GMFCS) and hip migration index (MI).
MATERIALS & METHODS:
Patient underwent SEMLS at HTAA from 2014 to 2018.Data were data taken from case notes during follow-up at rehabilitation clinic.
RESULTS:
There were 10 patients, 6 were boys.Mean age at surgery was 6.6 years old.7 having spastic diplegic and 1 each having triplegic and quadriplegic CP.
Table 1: Type of surgery
Patient
Adductor release
Hamstring release
Gastrocnemius recession
Tendon achilles lengthening
Posteromedial release
1
bilateral
bilateral
2
bilateral
bilateral
bilateral
3
bilateral
bilateral
4
bilateral
bilateral
5
bilateral
bilateral
Left
6
bilateral
bilateral
7
bilateral
8
bilateral
bilateral
9
bilateral
bilateral
10
bilateral
bilateral
2 patients had second surgery at 1 year apart:1 underwent talipes equinovarus deformity correction and another had repeated SEMLS.Only 5patients had pre and post-operative pelvis radiograph where 4 patients(80%) improved in hip MI.
Table 2: Improvement of GMFCS level
Patient
GMFCS
Level improvement
Pre
Post
1
IV
III
1 level
2
II
II
0
3
III
III
0
4
IV
III
1 level
5
V
V
0
6
IV
III
1 level
7
IV
IV
0
8
III
II
1 level
9
III
III
0
10
V
V
0
40% of patients have 1 level improvement. 75% of patients with GMFCS IV had improvement compared to GMFCS III (33%).
DISCUSSIONS:
73.5% has good improvement of hip MI postoperatively with 0.3% risk of hip surgery1.Incidence of hip displacement related to GMFCS level2.Evidence proved SEMLS improved gait3 and stability of GMFCS4.
CONCLUSION:
SEMLS may affect the improvement and stability of GMFCS level and hip MI; and that effect is level-dependent.
REFERENCES:
1Terjesen et al,Acta Orthopeadica,2009.
2Kentish M.et al,Journal of Peadiatric Rehabilitation Medicine,2011.
3Thomason et al,JBJS,2011.
4Godwin et al,Journal of Peadiatric Orthopaedic,2009. |
|---|