Article

Children with cerebral palsy often undergo multiple orthopaedic surgical
procedures in a single episode. Evidence of the effectiveness of individual
components within the overall package is sparse. The introduction of
musculoskeletal modelling in Oswestry has led to a more conservative management
approach being taken with hamstring muscles for children walking in a degree of
crouch. Muscles which were shown to be of at least normal length at initial
contact were not surgically lengthened, as would have been the case previously. A
retrospective review of 30 such patients was therefore possible, comparing 15
patients treated before the policy change who had their hamstrings lengthened
with 15 treated after who did not. All patients had pre and post operative gait
assessments and significant changes were observed for each group separately and
for the two groups when compared. The comparison revealed that preserving the
hamstrings does tend to reduce, and therefore normalize, the dynamic muscle
length. Examination of the two patient groups separately, however, reveals a more
complex picture with more global gait improvements seen when the hamstrings were
lengthened. No absolute recommendation can be made to inform the clinical
management of all children with normal to long hamstring muscles during gait. The
final decision of whether to include a hamstring lengthening will need to take
into account the characteristics of the individual child.
CI - Copyright (c) 2013 Elsevier B.V. All rights reserved.

Langue : ANGLAIS