title: [External evaluation of gait and functional changes after a single-session multiple myofibrotenotomy in school-aged children with spastic diplegia].
abstract: BACKGROUND
  About 23,000 patients with spasticity voluntarily chose to undergo a multiple myofiberotomy (MMF), which is an alternative technique consisting in sectioning soft tissues in order to relieve restrictions in joint movements. This technique, first employed by Ulzibat (Russia), is performed outside orthodox clinical controls.
  
  
  OBJECTIVE
  To perform an external evaluation of the effects of MMF on motor functionality and gait.
  
  
  METHODS
  The study was self-controlled and observation-based and was designed to evaluate the changes in functional variables -Gross Motor Function Classification System, E-dimension of the Gross Motor Function Measure (GMFM) and the Functional Mobility Scale- and 32 gait parameters (measured using analytical instruments) in 22 school-children with spastic diplegia (mean age: 9 years and 6 months; Q1-Q3: 7 years and 11 months to 11 years and 6 months) whose parents opted for an MMF (median of observation: 4 months; range: 3-7 months).
  
  
  RESULTS
  The analysis of hierarchical conglomerates used to determine topographic cut patterns in patients revealed that the surgeons applied one of three sets of cuts to each patient. On analysing the three groups of patients, it was observed that one group worsened overall and another underwent a general significant improvement in the E-dimension of the GMFM (difference of median: 4.86%; 95% confidence interval = 0-6.94%) after the MMF. Some of the gait parameters became significantly normalised (left: hip-flexion range, maximum dorsiflexion with support; right: speed, mean pelvic rotation with support and maximum dorsiflexion with support).
  
  
  CONCLUSIONS
  These findings do not back up or justify the use of MMF as a therapeutic option to treat spasticity. It has to be stressed that this technique must be avoided outside study protocols. Nevertheless, results do lay an objective base that may justify a clinical trial and long-term observation-based studies.
authors.forename: David
authors.initials: D
authors.lastname: Gómez-Andrés
authors.forename: Irene
authors.initials: I
authors.lastname: Pulido-Valdeolivas
authors.forename: Juan Andrés
authors.initials: JA
authors.lastname: Martín-Gonzalo
authors.forename: Javier
authors.initials: J
authors.lastname: López-López
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martínez-Caballero
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Barrena
authors.affiliation: Universidad Autonoma de Madrid, 29049 Madrid, Espana.
authors.forename: Estrella
authors.initials: E
authors.lastname: Rausell
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods