Planning of surgical treatment of upper extremity in patients with cerebral palsy
V. V. Umnov , V. A. Novikov , A. V. Zvozil’ , D. V. Zabolotskiy , A. S. Kozyrev
Traumatology and Orthopedics of Russia ›› 2013, Vol. 19 ›› Issue (2) : 57 -62.
Planning of surgical treatment of upper extremity in patients with cerebral palsy
The purpose - to devise the algorithm of patient examination with spastic hand to determine what the variant of surgical treatment is indicated. The variant of surgical treatment and it's results are depend on the cause of upper extremity deformation. Materials and methods. This study is based on a survey of children with cerebral palsy with lesions of the upper extremity. The main criterion for the selection of patients was the presence of the combined lesion of the upper extremity, where the cause of dysfunction hands are not only fixed contractures, but primary tonic. Was to survey 47 patients with spastic forms of cerebral palsy with the defeat of the upper limb, but the study group included only 26 of them in the ages of 7 to 18 years (average 12,1), as having the clinical picture both types of contractures. We have developed and applied a system of examinations, modeling expected outcome of selective neurotomy motor nerves of the upper limb, which allows to estimate the possible result of such treatment, and clearly differentiate tonic and fixed contracture. Results and conclusions. Based on the results of study we supposed that, using diagnostic blockade motor nerve at the period of planning surgical treatment help us to create temporary reversible model of selective neurotomy motor nerve branches and identify the type of contracture, degree of manifestation and functional perspective.
| [1] |
Бадалян Л.О. Детская неврология. М.: Медпрессинформ; 2001. 607 с. |
| [2] |
Ненько А.М. Хирургическое лечение контрактур и деформаций верхней конечности у детей с церебральными параличами. СПб., 1992. |
| [3] |
Семенова К.А. Восстановительное лечение больных с резидуальной стадией детского церебрального паралича. М.: Антидор; 1999. 384 с. |
| [4] |
Berweck S., Graham H.K., Heinen F. Spasticity in children: Handbook of botulinum toxin therapy. Oxford: Blackwell Science Limited; 2003. |
| [5] |
Bohannon R.W., Smith M.B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys. Ther. 1987;67(2):206-207. |
| [6] |
Das T.K., Park D.M. Botulinum toxin in treating spasticity. J. Clin. Pract. 1989; 43: 401-404. |
| [7] |
Enjalbert M. Classification fonctionnelle de la préhension chez l'hémiplégique adulte. In: Hémiplégie vasculaire de l'adulte et médecine de reeducation. Paris: Masson; 1988. Vol. 11. p. 212 — 223. |
| [8] |
Graham H.K., Selber P. Musculoskeletal aspects of cerebral palsy. J. Bone Joint Surg. 2003;85-B: 157-166. |
| [9] |
Leclercq C. Clinical aspects of spasticity. In: The hand. Philadelphia; 1991. Vol. IV. p. 677-683. |
| [10] |
Leclercq С. General assessment of the upper limb. Hand Clin. 2003; 19: 557-564. |
| [11] |
Mathiowetz V., Volland G., Kashman N., Weber K. Adult norms for the Box and Block Test of manual dexterity. J. Occup. Ther. 1985; 39(6):386-391. |
| [12] |
Memberg W.D., Crago P.E. Instrumented objects for quantitative evaluation of hand grasp. J. Rehabil. Res. Dev. 1997;34(1):82-90. |
| [13] |
Miller F. Cerebral palsy / F. Miller. — N.Y., 2005. — P. 387-432. |
/
| 〈 |
|
〉 |
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