Precise diagnosis and treatment of spastic cerebral palsy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HE Xiaoqing ,  XU Yongqing , YANG Xi

Institute of Trauma Orthopedic Surgery, the 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China;

Corresponding author：

XU Yongqing, Email: xuyongqingkm@163.net

Keywords：

Spastic cerebral palsy; surgical technique; precise diagnosis; individualized treatment

DOI：

10.7507/1002-1892.201903072

Video：

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Objective To summarize the advancement of precise diagnosis and treatment for spastic cerebral palsy in recent years.Methods The literature and own experiences were reviewed, and the surgical method, precise diagnosis, and personalized treatment of spastic cerebral palsy based on the classification of spastic cerebral palsy were summarized and analyzed.Results The common classification of spastic cerebral palsy are gross motor function classification system (GMFCS) and manual ability classification system (MACS). The surgical methods of spastic cerebral palsy can be divided into soft tissue surgery, nerve surgery, and bone and joint surgery. The precise diagnosis of spastic cerebral palsy includes qualitative diagnosis, localization diagnosis, and quantitative diagnosis. Based on precise diagnosis and classification, one or more corresponding surgical methods are selected for treatment.Conclusion The manifestations of spastic cerebral palsy are so diverse that it is necessary to select rational surgeries based on precise diagnosis to achieve individualized treatment.

Citation： HE Xiaoqing, XU Yongqing, YANG Xi. Precise diagnosis and treatment of spastic cerebral palsy. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1584-1588. doi: 10.7507/1002-1892.201903072 Copy

1.	Christensen D, Van Naarden Braun K, Doernberg NS, et al. Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning—Autism and Developmental Disabilities Monitoring Network, USA, 2008. Dev Med Child Neurol, 2014, 56(1): 59-65.
2.	Rosenbaum PL, Walter SD, Hanna SE, et al. Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA, 2002, 288(11): 1357-1363.
3.	Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol, 1997, 39(4): 214-223.
4.	Eliasson AC, Krumlinde-Sundholm L, Rösblad B, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol, 2006, 48(7): 549-554.
5.	Gunel MK, Mutlu A, Tarsuslu T, et al. Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy. Eur J Pediatr, 2009, 168(4): 477-485.
6.	Palisano RJ, Avery L, Gorter JW, et al. Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System. Dev Med Child Neurol, 2018, 60(10): 1026-1032.
7.	Burgess A, Boyd R, Ziviani J, et al. Stability of the Manual Ability Classification System in young children with cerebral palsy. Dev Med Child Neurol, 2019, 61(7): 798-804.
8.	Palisano RJ, Rosenbaum P, Bartlett D, et al. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol, 2008, 50(10): 744-750.
9.	Pilloni G, Pau M, Costici F, et al. Use of 3D gait analysis as predictor of Achilles tendon lengthening surgery outcomes in children with cerebral palsy. Eur J Phys Rehabil Med, 2019, 55(2): 250-257.
10.	Klotz MCM, Krautwurst BK, Hirsch K, et al. Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy: A randomized controlled trial. Gait Posture, 2018, 60: 217-224.
11.	Tsang STJ, McMorran D, Robinson L, et al. A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy. Gait Posture, 2016, 50: 23-27.
12.	Kläusler M, Speth BM, Brunner R, et al. Long-term follow-up after tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy. Gait Posture, 2017, 58: 457-462.
13.	Kondo I, Hosokawa K, Iwata M, et al. Effectiveness of selective muscle-release surgery for children with cerebral palsy: longitudinal and stratified analysis. Dev Med Child Neurol, 2004, 46(8): 540-547.
14.	Čobeljić G, Rajković S, Bajin Z, et al. The results of surgical treatment for pronation deformities of the forearm in cerebral palsy after a mean follow-up of 17.5 years. J Orthop Surg Res, 2015, 10: 106.
15.	El-Said NS. Selective release of the flexor origin with transfer of flexor carpi ulnaris in cerebral palsy. J Bone Joint Surg (Br), 2001, 83(2): 259-262.
16.	Thilmann AF, Fellows SJ, Garms E. The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. Brain, 1991, 114(Pt 1A): 233-244.
17.	何强勇, 赵勇, 尹靖宇, 等. 选择性脊神经后根切断术的脑性瘫痪患者选择标准. 中国康复医学杂志, 2018, 33(1): 117-121.
18.	刘敏, 胡廷泽, 韦福康. 选择性脊神经后根切断术治疗痉挛性脑瘫的综述. 中国修复重建外科杂志, 1999, 13(3): 183-185.
19.	Purohit AK, Raju BS, Kumar KS, et al. Selective musculocutaneous fasciculotomy for spastic elbow in cerebral palsy: a preliminary study. Acta Neurochir (Wien), 1998, 140(5): 473-478.
20.	Deltombe T, Lejeune T, Gustin T. Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? Ann Phys Rehabil Med, 2019, 62(4): 220-224.
21.	Wang S, Miao S, Zhuang P, et al. Assessment of surface electromyographic clinical analysis of selective femoral neurotomy on cerebral palsy with stiff knee. J Neurosci Methods, 2011, 199(1): 98-102.
22.	高纯志, 吴晗, 肖鹏, 等. Ilizarov 技术结合有限手术治疗青少年痉挛性马蹄内翻足畸形. 中国修复重建外科杂志, 2018, 32(2): 182-186.
23.	Yu S, Rethlefsen SA, Wren TA, et al. Long-term ambulatory change after lower extremity orthopaedic surgery in children with cerebral palsy: a retrospective review. J Pediatr Orthop, 2015, 35(3): 285-289.
24.	Feger MA, Lunsford CD, Sauer LD, et al. Comparative effects of multilevel muscle tendon surgery, osteotomies, and dorsal rhizotomy on functional and gait outcome measures for children with cerebral palsy. PM R, 2015, 7(5): 485-493.
25.	Canavese F, Marengo L, de Coulon G. Results and complications of percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in 54 consecutively operated GMFCS level IV and V cerebral palsy patients. Eur J Orthop Surg Traumatol, 2017, 27(4): 513-519.
26.	Finlayson L, Czuba T, Gaston MS, et al. The head shaft angle is associated with hip displacement in children at GMFCS levels Ⅲ-Ⅴ—a population based study. BMC Musculoskelet Disord, 2018, 19(1): 356.
27.	施镇国, 叶志英. 小儿脑瘫治疗进展概况. 实用中西医结合临床, 2018, 18(11): 180-183.
28.	Yu Y, Chen X, Cao S, et al. Gait synergetic neuromuscular control in children with cerebral palsy at different gross motor function classification system levels. J Neurophysiol, 2019, 121(5): 1680-1691.
29.	Putz C, Blessing AK, Erhard S, et al. Long-term results of multilevel surgery in adults with cerebral palsy. Int Orthop, 2019, 43(2): 255-260.

1. Christensen D, Van Naarden Braun K, Doernberg NS, et al. Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning—Autism and Developmental Disabilities Monitoring Network, USA, 2008. Dev Med Child Neurol, 2014, 56(1): 59-65.
2. Rosenbaum PL, Walter SD, Hanna SE, et al. Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA, 2002, 288(11): 1357-1363.
3. Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol, 1997, 39(4): 214-223.
4. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol, 2006, 48(7): 549-554.
5. Gunel MK, Mutlu A, Tarsuslu T, et al. Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy. Eur J Pediatr, 2009, 168(4): 477-485.
6. Palisano RJ, Avery L, Gorter JW, et al. Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System. Dev Med Child Neurol, 2018, 60(10): 1026-1032.
7. Burgess A, Boyd R, Ziviani J, et al. Stability of the Manual Ability Classification System in young children with cerebral palsy. Dev Med Child Neurol, 2019, 61(7): 798-804.
8. Palisano RJ, Rosenbaum P, Bartlett D, et al. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol, 2008, 50(10): 744-750.
9. Pilloni G, Pau M, Costici F, et al. Use of 3D gait analysis as predictor of Achilles tendon lengthening surgery outcomes in children with cerebral palsy. Eur J Phys Rehabil Med, 2019, 55(2): 250-257.
10. Klotz MCM, Krautwurst BK, Hirsch K, et al. Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy: A randomized controlled trial. Gait Posture, 2018, 60: 217-224.
11. Tsang STJ, McMorran D, Robinson L, et al. A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy. Gait Posture, 2016, 50: 23-27.
12. Kläusler M, Speth BM, Brunner R, et al. Long-term follow-up after tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy. Gait Posture, 2017, 58: 457-462.
13. Kondo I, Hosokawa K, Iwata M, et al. Effectiveness of selective muscle-release surgery for children with cerebral palsy: longitudinal and stratified analysis. Dev Med Child Neurol, 2004, 46(8): 540-547.
14. Čobeljić G, Rajković S, Bajin Z, et al. The results of surgical treatment for pronation deformities of the forearm in cerebral palsy after a mean follow-up of 17.5 years. J Orthop Surg Res, 2015, 10: 106.
15. El-Said NS. Selective release of the flexor origin with transfer of flexor carpi ulnaris in cerebral palsy. J Bone Joint Surg (Br), 2001, 83(2): 259-262.
16. Thilmann AF, Fellows SJ, Garms E. The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. Brain, 1991, 114(Pt 1A): 233-244.
17. 何强勇, 赵勇, 尹靖宇, 等. 选择性脊神经后根切断术的脑性瘫痪患者选择标准. 中国康复医学杂志, 2018, 33(1): 117-121.
18. 刘敏, 胡廷泽, 韦福康. 选择性脊神经后根切断术治疗痉挛性脑瘫的综述. 中国修复重建外科杂志, 1999, 13(3): 183-185.
19. Purohit AK, Raju BS, Kumar KS, et al. Selective musculocutaneous fasciculotomy for spastic elbow in cerebral palsy: a preliminary study. Acta Neurochir (Wien), 1998, 140(5): 473-478.
20. Deltombe T, Lejeune T, Gustin T. Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? Ann Phys Rehabil Med, 2019, 62(4): 220-224.
21. Wang S, Miao S, Zhuang P, et al. Assessment of surface electromyographic clinical analysis of selective femoral neurotomy on cerebral palsy with stiff knee. J Neurosci Methods, 2011, 199(1): 98-102.
22. 高纯志, 吴晗, 肖鹏, 等. Ilizarov 技术结合有限手术治疗青少年痉挛性马蹄内翻足畸形. 中国修复重建外科杂志, 2018, 32(2): 182-186.
23. Yu S, Rethlefsen SA, Wren TA, et al. Long-term ambulatory change after lower extremity orthopaedic surgery in children with cerebral palsy: a retrospective review. J Pediatr Orthop, 2015, 35(3): 285-289.
24. Feger MA, Lunsford CD, Sauer LD, et al. Comparative effects of multilevel muscle tendon surgery, osteotomies, and dorsal rhizotomy on functional and gait outcome measures for children with cerebral palsy. PM R, 2015, 7(5): 485-493.
25. Canavese F, Marengo L, de Coulon G. Results and complications of percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in 54 consecutively operated GMFCS level IV and V cerebral palsy patients. Eur J Orthop Surg Traumatol, 2017, 27(4): 513-519.
26. Finlayson L, Czuba T, Gaston MS, et al. The head shaft angle is associated with hip displacement in children at GMFCS levels Ⅲ-Ⅴ—a population based study. BMC Musculoskelet Disord, 2018, 19(1): 356.
27. 施镇国, 叶志英. 小儿脑瘫治疗进展概况. 实用中西医结合临床, 2018, 18(11): 180-183.
28. Yu Y, Chen X, Cao S, et al. Gait synergetic neuromuscular control in children with cerebral palsy at different gross motor function classification system levels. J Neurophysiol, 2019, 121(5): 1680-1691.
29. Putz C, Blessing AK, Erhard S, et al. Long-term results of multilevel surgery in adults with cerebral palsy. Int Orthop, 2019, 43(2): 255-260.

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