Simultaneous multiple operations for spastic diplegia : outcome and functional assessment of walking in 18 patients
We assessed the outcome after simultaneous multiple operations performed on 18 children with spastic diplegia, with emphasis on the changes in the physiological cost index (PCI) of walking. Fourteen patients had a measurable reduction at one year, but the more severely affected patients took up to t...
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| Veröffentlicht in: | Journal of bone and joint surgery. British volume 1993-05, Vol.75 (3), p.488-494 |
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| container_end_page | 494 |
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| container_issue | 3 |
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| container_title | Journal of bone and joint surgery. British volume |
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| creator | NENE, A. V EVANS, G. A PATRICK, J. H |
| description | We assessed the outcome after simultaneous multiple operations performed on 18 children with spastic diplegia, with emphasis on the changes in the physiological cost index (PCI) of walking. Fourteen patients had a measurable reduction at one year, but the more severely affected patients took up to two years to reach a new functional plateau. The level of the preoperative PCI allows prediction of the outcome of surgery in terms of reducing the effort of walking, or improving its appearance only. Intrapelvic intramuscular psoas tenotomy produced an improvement of hip flexion deformity in 15 of 17 patients without the loss of muscle power to initiate the swing phase. Fractional lengthening corrected hamstring tightness in 17 cases, and the mean popliteal angle was reduced from 63 degrees preoperatively to 30.2 degrees, with almost complete resolution of the fixed knee flexion deformity present in ten patients. Distal transfer of the rectus femoris, when it was shown to be contracting inappropriately, improved the knee flexion arc during walking from a mean of 28.3 degrees to 45.2 degrees. |
| doi_str_mv | 10.1302/0301-620x.75b3.8496229 |
| format | Article |
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Fractional lengthening corrected hamstring tightness in 17 cases, and the mean popliteal angle was reduced from 63 degrees preoperatively to 30.2 degrees, with almost complete resolution of the fixed knee flexion deformity present in ten patients. Distal transfer of the rectus femoris, when it was shown to be contracting inappropriately, improved the knee flexion arc during walking from a mean of 28.3 degrees to 45.2 degrees.</description><identifier>ISSN: 0301-620X</identifier><identifier>EISSN: 2044-5377</identifier><identifier>DOI: 10.1302/0301-620x.75b3.8496229</identifier><identifier>PMID: 8496229</identifier><identifier>CODEN: JBSUAK</identifier><language>eng</language><publisher>London: British Editorial Society of Bone and Joint Surgery</publisher><subject>Adolescent ; Biological and medical sciences ; Cerebral Palsy - complications ; Cerebral Palsy - physiopathology ; Cerebral Palsy - surgery ; Child ; Contracture - diagnosis ; Contracture - etiology ; Contracture - pathology ; Diagnosis, Computer-Assisted ; Electromyography ; Energy Metabolism ; Evaluation Studies as Topic ; Female ; Gait ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Heart Rate ; Humans ; Male ; Medical sciences ; Muscle Spasticity ; Nervous system (semeiology, syndromes) ; Neurology ; Physical Exertion ; Range of Motion, Articular ; Severity of Illness Index ; Treatment Outcome ; Videotape Recording ; Walking</subject><ispartof>Journal of bone and joint surgery. 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H</creatorcontrib><title>Simultaneous multiple operations for spastic diplegia : outcome and functional assessment of walking in 18 patients</title><title>Journal of bone and joint surgery. British volume</title><addtitle>J Bone Joint Surg Br</addtitle><description>We assessed the outcome after simultaneous multiple operations performed on 18 children with spastic diplegia, with emphasis on the changes in the physiological cost index (PCI) of walking. Fourteen patients had a measurable reduction at one year, but the more severely affected patients took up to two years to reach a new functional plateau. The level of the preoperative PCI allows prediction of the outcome of surgery in terms of reducing the effort of walking, or improving its appearance only. Intrapelvic intramuscular psoas tenotomy produced an improvement of hip flexion deformity in 15 of 17 patients without the loss of muscle power to initiate the swing phase. Fractional lengthening corrected hamstring tightness in 17 cases, and the mean popliteal angle was reduced from 63 degrees preoperatively to 30.2 degrees, with almost complete resolution of the fixed knee flexion deformity present in ten patients. Distal transfer of the rectus femoris, when it was shown to be contracting inappropriately, improved the knee flexion arc during walking from a mean of 28.3 degrees to 45.2 degrees.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Cerebral Palsy - complications</subject><subject>Cerebral Palsy - physiopathology</subject><subject>Cerebral Palsy - surgery</subject><subject>Child</subject><subject>Contracture - diagnosis</subject><subject>Contracture - etiology</subject><subject>Contracture - pathology</subject><subject>Diagnosis, Computer-Assisted</subject><subject>Electromyography</subject><subject>Energy Metabolism</subject><subject>Evaluation Studies as Topic</subject><subject>Female</subject><subject>Gait</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Muscle Spasticity</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Physical Exertion</subject><subject>Range of Motion, Articular</subject><subject>Severity of Illness Index</subject><subject>Treatment Outcome</subject><subject>Videotape Recording</subject><subject>Walking</subject><issn>0301-620X</issn><issn>2044-5377</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkEtLxEAQhAdR1vXxE5Q5iLesM5lJJvGmiy9Y8KCCt9A7j2U0ycR0gvrvTdiop26or6rpIuSUswUXLL5ggvEojdnXQiVrschknsZxvkPmMZMySoRSu2T-C73ukwPEN8aYTBIxI7MJnxN88lVfdlDb0CMdV9-UlobGttD5UCN1oaXYAHZeUzOKGw_0koa-06GyFGpDXV_rEYaSAqJFrGzd0eDoJ5Tvvt5QX1Oe0WZIHAQ8InsOSrTH0zwkL7c3z8v7aPV497C8WkVaMt5FYHIDmV5rw2xiY5kZLnKjjVJrnjkuWZ4YHafgcu10omQWq9Tk1nBlLAfg4pCcb3ObNnz0Frui8qhtWW6_LdRgkiplA5huQd0GxNa6oml9Be13wVkxtl2MRRZjkYPpWhRTfYPxZLrQrytr_mz_-tmkA2ooXQu19viHSaU4yzPxA5GkiwY</recordid><startdate>19930501</startdate><enddate>19930501</enddate><creator>NENE, A. 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H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-ad9da8cbcd0e5e248d139dcd77b18f14095dc26af9cfc5748276d9ed17de1aa13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Cerebral Palsy - complications</topic><topic>Cerebral Palsy - physiopathology</topic><topic>Cerebral Palsy - surgery</topic><topic>Child</topic><topic>Contracture - diagnosis</topic><topic>Contracture - etiology</topic><topic>Contracture - pathology</topic><topic>Diagnosis, Computer-Assisted</topic><topic>Electromyography</topic><topic>Energy Metabolism</topic><topic>Evaluation Studies as Topic</topic><topic>Female</topic><topic>Gait</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Muscle Spasticity</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Physical Exertion</topic><topic>Range of Motion, Articular</topic><topic>Severity of Illness Index</topic><topic>Treatment Outcome</topic><topic>Videotape Recording</topic><topic>Walking</topic><toplevel>online_resources</toplevel><creatorcontrib>NENE, A. V</creatorcontrib><creatorcontrib>EVANS, G. A</creatorcontrib><creatorcontrib>PATRICK, J. H</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of bone and joint surgery. British volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>NENE, A. V</au><au>EVANS, G. A</au><au>PATRICK, J. H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Simultaneous multiple operations for spastic diplegia : outcome and functional assessment of walking in 18 patients</atitle><jtitle>Journal of bone and joint surgery. British volume</jtitle><addtitle>J Bone Joint Surg Br</addtitle><date>1993-05-01</date><risdate>1993</risdate><volume>75</volume><issue>3</issue><spage>488</spage><epage>494</epage><pages>488-494</pages><issn>0301-620X</issn><eissn>2044-5377</eissn><coden>JBSUAK</coden><abstract>We assessed the outcome after simultaneous multiple operations performed on 18 children with spastic diplegia, with emphasis on the changes in the physiological cost index (PCI) of walking. Fourteen patients had a measurable reduction at one year, but the more severely affected patients took up to two years to reach a new functional plateau. The level of the preoperative PCI allows prediction of the outcome of surgery in terms of reducing the effort of walking, or improving its appearance only. Intrapelvic intramuscular psoas tenotomy produced an improvement of hip flexion deformity in 15 of 17 patients without the loss of muscle power to initiate the swing phase. Fractional lengthening corrected hamstring tightness in 17 cases, and the mean popliteal angle was reduced from 63 degrees preoperatively to 30.2 degrees, with almost complete resolution of the fixed knee flexion deformity present in ten patients. Distal transfer of the rectus femoris, when it was shown to be contracting inappropriately, improved the knee flexion arc during walking from a mean of 28.3 degrees to 45.2 degrees.</abstract><cop>London</cop><pub>British Editorial Society of Bone and Joint Surgery</pub><pmid>8496229</pmid><doi>10.1302/0301-620x.75b3.8496229</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Biological and medical sciences Cerebral Palsy - complications Cerebral Palsy - physiopathology Cerebral Palsy - surgery Child Contracture - diagnosis Contracture - etiology Contracture - pathology Diagnosis, Computer-Assisted Electromyography Energy Metabolism Evaluation Studies as Topic Female Gait Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Heart Rate Humans Male Medical sciences Muscle Spasticity Nervous system (semeiology, syndromes) Neurology Physical Exertion Range of Motion, Articular Severity of Illness Index Treatment Outcome Videotape Recording Walking |
| title | Simultaneous multiple operations for spastic diplegia : outcome and functional assessment of walking in 18 patients |
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