title: Improvement of ambulatory function with multilevel soft tissue surgery in children with spastic diplegic cerebral palsy.
abstract: Single Event Multilevel soft tissue surgery in spastic diplegic children also was effective for improving ambulatory function obviously as multilevel bone and soft tissue surgery. Just muscle and tendon surgery seem to be enough for better lever arm dysfunction of the lower extremity. It has safe, simple and rapid recovery.
  
  
  OBJECTIVE
  Gross Motor Functional Classification System (GMFCS) improvement after single event multilevel soft tissue surgery had been observed in these study groups of patients.
  
  
  METHODS
  Retrospective review in 93 spastic diplegic children who were more than 3 years old, had ability to understand communication, at least leaned sitting and one-hand gross function ability had been operated on by single event multilevel soft tissue surgery. GMFCS was assessed at the time of pre-operation and 6-12 months after operation. Analyzing GMFCS change was performed by statistics.
  
  
  RESULTS
  Average 7 site surgery per one patient, 84% GMFCS level improvement and 16% GMFCS level non-improvement were reported. Nine cases (9.7%) were improved 2 level of GMFCS and 74% improved 1 level. GMFCS level compared between pre- and post surgery had changed by the significant statistic (p < 0.001). The average GMFCS level improvement for all groups was 0.93 level. The average age in the improved group (75 months old) was less than the non-improved group (92 month old), was a trend difference in statistic (p = 0.032).
  
  
  CONCLUSIONS
  Single Event Multilevel Soft tissue surgery was effective in improving the GMFCS level average 1 level. It changed ambulatory function of spastic diplegic CP children obviously, immediately and safely. Younger age might get more benefit than older children.
authors: Department of Orthopedics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand. sivtk@hotmail.com
authors: Verasak
authors: V
authors: Thamkunanon
mesh_terms: D000203:Activities of Daily Living; D002547:Cerebral Palsy / Q000145:classification* / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000145:classification*; D009128:Muscle Spasticity; D018482:Muscle, Skeletal / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D011379:Prognosis; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome; D016138:Walking