Impacto de las cirugías múltiples, en un solo tiempo quirúrgico, sobre el patrón de marcha en niños con parálisis cerebral

Abstract

Introduction: Cerebral Palsy (CP) is the most incapacitating neurological disease in children, its natural history trend to a motor and functional impairment. This study seeks to establish if Single Event Multi-Level Surgeries (SEMLS) of the lower limbs, maintain the motor and functional level. Methods: Analytic cohort study. A group of patients undergoing SEMLS was compared against a group of patients who did not undergo to any surgical intervention, at the Instituto de Ortopedia Infantil Roosevelt. Patients were evaluated with two Motion Analysis Laboratory (MAL) and outcomes were measured by the change in the Gait Profile Score (GPS) and Gross Motor Functional Classification System (GMFCS). Results: 109 patients met the selection criteria, 67 patients underwent surgery and 42 patients were not treated surgically. The patients who underwent surgery improved the mean GPS overall (difference -1.94; p = 0.002) compared with not operated patients (difference 1.74; p = 0.001), indicating a significant improvement in gait kinematics. In a multivariate model, the patient had a change to maintain their gait pattern of 78% if was operated, while the probability of the not operate patient decreases to 37%. The GMFCS showed no significant changes between the groups. Discussion: The SEMLS of the lower limbs maintain or improve significantly its gait pattern in patients with CP. This study highlights the use of MAL for follow-up, and use of GPS is suggested to assess results in these patients.