Correction of neuroorthopedic disorders in children with cerebral palsy

Abstract


Introduction. In the National Medical Research Center for Children’s Health of the Ministry of health of Russia there was introduced a system of comprehensive treatment of cerebral palsy children using a multidisciplinary approach with the patient’s habilitation potential. According to the European consensus of treatment of cerebral palsy, there are main groups of therapeutic effects: oral anti-spastic pharmacotherapy, orthopedic surgery, botulinum therapy, intrathecal administration of baclofen, orthosis, functional therapy. Orthopaedic surgery is necessary for the treatment of secondary joint contractures and skeletal deformities in cerebral palsy.

The aim of the study was to optimize the comprehensive abilitation of children with cerebral palsy, taking into account the prognosis of the patient’s motor development.

Patients and Methods. An analysis of the effectiveness of surgical treatment of 718 patients with neuroorthopedic pathology against the background of spastic forms of cerebral palsy was made. Among the operated patients, 290 patients had spastic instability of the hip joints, 147 cases suffered from contractures or axial deformities of the lower extremities at the level of the knee joints, 245 – neurogenic deformities of the feet, and 36 – with deformities of the thoracic spine. Patients with neuroorthopedic pathology who were operated at the second stage (n = 476) made up the 2nd group (a prospective study). They were treated in the neuro-orthopaedic Department with Orthopaedics of the National Medical Research Center for Children’s Health from 2013 to 2018 (after the restructuring of the traumatological and orthopedic Department in 2013) with the use of a personalized multidisciplinary approach to the correction of neurogenic musculoskeletal disorders based on the forecast of motor development. The comparative standardized analysis of motor activity of patients before and after surgery was evaluated dynamically according to a 10-point scale-the Gillette FAQ (Gillette Functional Assessment Questionnaire).

Results. Based on the analysis of functional results, the surgical treatment was concluded to be more effective in group 2, where it was planned based on the prognosis of motor development of a cerebral palsy child. A comparative analysis of the duration of periods of postoperative rehabilitation of patients with musculoskeletal disorders against the background of cerebral palsy showed a significant reduction in the rehabilitation period of patients whose treatment took into account the forecast of motor development according to GMFCS and used simultaneous multi-level surgical interventions.

Conclusion. A multidisciplinary approach to the treatment of this category of patients allowed qualitatively and quantitatively increasing the effectiveness of surgical and reconstructive treatment of children with spastic forms of cerebral palsy.


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About the authors

O. B. Chelpachenko

National Medical Research Center for Children’s Health

Author for correspondence.
Email: chelpachenko81@mail.ru

Russian Federation, Moscow

MD, Ph.D.

K. V. Zherdev

National Medical Research Center for Children’s Health

Email: chelpachenko81@mail.ru

Russian Federation, Moscow

A. P. Fisenko

National Medical Research Center for Children’s Health

Email: chelpachenko81@mail.ru
ORCID iD: 0000-0002-7893-1863

Russian Federation, Moscow

MD, Ph.D., DSc., Prof.

E. Yu. Dyakonova

National Medical Research Center for Children’s Health

Email: chelpachenko81@mail.ru

Russian Federation, Moscow

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Copyright (c) 2020 Chelpachenko O.B., Zherdev K.V., Fisenko A.P., Dyakonova E.Y.

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