Comparative analysis of the effectiveness of bone-plastic and soft-tissue reconstructive operations in children with cerebral palsy in equino-plano-valgus deformity of the foot

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Abstract


Aim. To carry out a comparative analysis of approaches to the surgical correction of equinoplonal valgus deformity of the feet in children with infantile cerebral palsy.

Materials and methods. A retrospective clinical and radiological analysis of the results of surgical treatment of 109 patients (194 feet) with equinoplovalgus deformity of the feet was performed. The patients are divided into four groups according to the method of surgical correction and age periods. Tendon-muscle plastics: in study group 1a, 21 children 4–7 years old and 23 children 8–11 years old in group 1b. Osteoplastic surgery: 28 children 4–7 years old in study group 2a and 34 children in group 2b. The average age of the patients was 8.2±2.8 years. According to the neurological status, patients of I – III levels of motor development (according to the Gross Motor Function Classification System – GMFCS) with hemiparesis, diplegia and tetraparesis were examined. Comparative analysis was carried out with a reference group consisting of 40 children (71 feet) with exostotic chondrodysplasia or injury to the ligamentous apparatus of one foot at the age of 4–11 years without neurological pathology and foot deformities.

Results. A significant improvement in clinical and radiological parameters was determined in all study groups 14±2 months after surgical treatment in comparison with preoperative parameters. Most of the values approached the established reference intervals. Assessment 34±3 months after surgical treatment in study groups 1a and 1b showed a decrease in the studied clinical and radiological parameters. The results after 34±3 months in study groups 2a and 2b with performed osteoplastic interventions did not reveal significant differences from the parameters after 14±2 months. Such results indicate the preservation of early results of surgical treatment when using osteoplastic methods for correcting foot deformities in children 4–11 years old. The results obtained with the use of soft tissue surgical techniques in children 8–11 years old indicate a high recurrence rate in the long term.

Conclusion. The study of functional status parameters according to the Gillette Functional Assessment Questionnaire 22±4 months after surgery revealed an increase in functional status in 42.85% of children in group 1a and 71.43% in group 2a. In group 1b, an increase in functional status was noted in 30.45% of children, in group 2b – in 67.65% of children. In 4.33% of children of the primary school group, tendon-muscle plastic showed negative dynamics in the functional status. The data obtained in general indicate that there are great prospects for long-term correction of foot deformity by means of osteoplastic operations in comparison with surgery of soft tissue structures.


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About the authors

Pavel A. Zubkov

National Medical Research Center for Children’s Health

Author for correspondence.
Email: zpa992@gmail.com
ORCID iD: 0000-0001-9408-8004

Russian Federation, Moscow

Graduate Student

Konstantin V. Zherdev

National Medical Research Center for Children’s Health

Email: drzherdev@mail.ru
ORCID iD: 0000-0003-3698-6011

Russian Federation, Moscow

D. Sci. (Med.)

Oleg B. Chelpachenko

National Medical Research Center for Children’s Health

Email: chelpachenko81@mail.ru
ORCID iD: 0000-0002-0333-3105

Russian Federation, Moscow

Cand. Sci. (Med.)

Sergei P. Yatsyk

National Medical Research Center for Children’s Health

Email: yatsyk@nczd.ru
ORCID iD: 0000-0001-6966-1040

Russian Federation, Moscow

D. Sci. (Med.), Prof., Corr. Memb. RAS

Aleksandr A. Petelguzov

National Medical Research Center for Children’s Health

Email: petelguzov.a@nczd.ru
ORCID iD: 0000-0002-6686-4042

Russian Federation, Moscow

traumatologist

Igor V. Timofeev

National Medical Research Center for Children’s Health

Email: doctor_timofeev@mail.ru

Russian Federation, Moscow

Cand. Sci. (Med.)

Aleksandr N. Majorov

Children’s Tuberculosis Sanatorium “Kiritsy”

Email: secr@sankir.ru

Russian Federation, Kiritsy

D. Sci. (Med.)

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Study group 1a (tendon-muscle plastics) 22±4 months after

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2.
Fig. 2. Study group 2a (osteoplastic surgery) 22±4 months after surgery (n=28; preschool children 4–7 years old).

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3.
Fig. 3. Study group 1b (tendon-muscle plasty) 22±4 months after surgery (n=23; preschool children 8–11 years old).

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4.
Fig. 4. Study group 2b (osteoplastic operations) 22±4 months after

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