Article

Internal rotation gait constitutes a complex gait disorder in
bilateral spastic cerebral palsy (BSCP) including static torsional and dynamic
components resulting in lever arm dysfunction.
Although femoral derotation
osteotomy (FDO) is a standard procedure to correct increased femoral anteversion
in children, unpredictable outcome has been reported.
The effect of FDO when it
is done as part of single-event multilevel surgery (SEMLS) in adulthood has not
been investigated.
METHODS: In this study mid-term data of 63 adults with BSCP
and internal rotation gait, undergoing SEMLS including FDO were analyzed pre- and
1.7 years postoperatively by clinical examination and 3D-instrumented gait
analysis. All legs were categorized as the more or less involved side to consider
asymmetry. The mean hip rotation in stance preoperatively and the intraoperative
derotation was correlated with the difference pre- and postoperatively. RESULTS:
The group as a whole experienced the following results postoperatively: improved
mean hip rotation in stance
(p=0.0001), mean foot progression angle (p=0.0001)
and a significant improvement of the clinical parameter: passive internal and
external hip rotation, midpoint and anteversion (p=0.0001) for both legs
separately. With regard to the less and more involved side, clinical and
kinematic parameters showed comparable significant changes (p=0.0001). The
anteversion improved significantly in proximal compared to distal FDO (p=0.03).
CONCLUSION: This study emphasizes an overall good correction of internal rotation
gait in adults with bilateral involvement after FDO. However, the results are
more predictable in adults compared to studies reporting outcome after FDO in
children.
CI - Copyright (c) 2016 Elsevier B.V. All rights reserved.

Langue : ANGLAIS