[Single event multilevel surgery to improve gait in diplegic cerebral palsy - a prospective controlled trial].
OBJECTIVE
To evaluate prospectively the outcome of gait-improvement surgery in children with spastic diplegia.


METHODS
Three-dimensional gait analysis was performed in twenty children with spastic diplegia. Ten children underwent single event multilevel surgery for gait improvement. Indications for individual procedures followed a fixed set of selection criteria. The other ten children continued with their physiotherapy programme and served as a control group. A second gait analysis was performed in all children after 1.5 years. Time-distance parameters and kinematics of the pelvis, hip, knee and ankle joints in the sagittal plane served as main outcome measures


RESULTS
The patients walked faster with an increased stride length after surgery in comparison to the conservatively treated controls. The average pelvic tilt increased slightly and the range of motion of the knee joint increased considerably after multilevel surgery. The motion at the ankle remained unchanged over the study period in both the groups. An improved knee extension during the stance phase of gait served to improve stance limb stability and facilitated an unhindered swing phase of the opposite limb.


CONCLUSIONS
This prospective trial showed favourable changes in gait function after multilevel surgery in spastic diplegic children.
Zwick
E B
EB
Abteilung für Kinderorthopädie, Klinik für Kinderchirurgie, Karl-Franzens-Universität Graz, Germany. ernst.zwick@kfunigraz.ac.at
Saraph
V
V
Strobl
W
W
Steinwender
G
G
D002648:Child; D005260:Female; D005500:Follow-Up Studies; D020235:Gait Apraxia / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000601:surgery*; D009460:Neurologic Examination; D010043:Outcome and Process Assessment, Health Care; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D014741:Video Recording