儿童脑瘫的微创SPML手术:项目开发。

IF 1.3 Q3 SURGERY
Minimally Invasive Surgery Pub Date : 2020-08-19 eCollection Date: 2020-01-01 DOI:10.1155/2020/5124952
Dana L Wild, Caroline W Stegink-Jansen, Christine P Baker, Kelly D Carmichael, David A Yngve
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引用次数: 6

摘要

脑瘫是儿童严重身体残疾的最常见原因,改善手术和康复护理对减轻脑瘫负担至关重要。选择性经皮肌筋膜延长(SPML)手术是一种微创方法,旨在通过延长收缩的肌肉骨骼组织来改善行动。关于SPML治疗CP患儿的手术方法、疗效和安全性的信息尚缺乏。我们的研究第一阶段是一项多部位SPML改善CP患儿功能活动能力的“原理验证”研究,第二阶段评估后续患者系列的安全性、再手术率和疗效。第一阶段是17名儿童(平均年龄7.6岁)的重复测量病例系列研究。一位物理治疗师,不知道外科医生的测量结果,使用标准化步态路径的视频记录,测量了SPML手术前后双侧膝盖和脚踝的运动。术前、术后及电话随访分别采用功能活动能力量表(FMS) 5、50和500个结果。在第二阶段,从2006年到2017年,在更大的连续队列中实施了多部位SPLM手术。回顾性分析并发症、再手术率及疗效。1期结果显示,患儿行走时膝关节和踝关节活动得到改善,术后FMS改善5,50和500(平均6.3个月)。在第二次随访时(平均33.3个月),FMS 500得分继续改善,而FMS 5和FMS 50得分维持不变。在第2期,并发症发生率为2.4%,再手术率(包括因成熟导致的再手术)在8%至13%之间。498例踝关节马蹄足得到改善。总之,在一个专门的中心,单事件,多级别SPML手术儿童CP安全改善膝和踝关节的动态角度运动和日常活动的结果。未来需要对新入路外科医生的培训需求进行教育研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development.

Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development.

Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development.

Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development.

Improvements in surgical and rehabilitation care are critical to lessen the burden of cerebral palsy (CP), the most common cause of severe physical disability in childhood. The selective percutaneous myofascial lengthening (SPML) surgical procedure is a minimally invasive method designed to improve ambulation by lengthening contracted musculoskeletal tissues. Information on surgical procedures, efficacy, and safety of SPML for children with CP is lacking. Phase 1 of our research is a "proof-of-principle" study for multisite SPML to improve functional mobility of children with CP, and Phase 2 assesses safety, reoperation rates, and efficacy over time in subsequent patient series. Phase 1 was a repeated measurement case series study of 17 children (mean age 7.6 years). One physical therapist, blinded to the surgeon's measurements, measured bilateral knee and ankle motion before and after SPML procedures, using video recordings of a standardized gait path. Functional Mobility Scale (FMS) 5, 50, and 500 outcomes were taken pre- and postoperatively and via telephone follow-up. In Phase 2, multisite SPLM surgeries were implemented in larger successive cohorts from 2006 to 2017. Complications, reoperation rates, and efficacy were retrospectively analyzed. Phase 1 results showed improvement in the children's knee and ankle motion while ambulating and improved FMS 5, 50, and 500 outcomes postoperatively (mean, 6.3 months). At second follow-up (mean 33.3 months), FMS 500 scores continued improvement, while FMS 5 and FMS 50 scores maintained. During Phase 2, the complication rate was 2.4%, and reoperation rates (including reoperations due to maturation) were between 8% and 13%. Improvements to correct ankle equinus were recorded in 498 cases. In conclusion, in a specialized center, single-event, multilevel SPML surgeries of children with CP safely improved ambulatory knee and ankle angle motion and daily mobility outcomes. Future educational studies of training needs for surgeons new to the approach are needed.

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CiteScore
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自引率
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