Results of treatment of planovalgus deformity in children with cerebral palsy
Keywords:mobile planovalgus deformity, children, cerebral palsy, algorithm of treatment
Background. The purpose was to present a differentiated approach and analysis of the results of surgical treatment of mobile planovalgus deformity in children with cerebral palsy. Materials and methods. There was performed a retrospective analysis of the cases of 39 patients with mobile planovalgus deformity and spastic cerebral palsy, who underwent various surgical treatment options. According to the applied regimen of surgical treatment with mobile planovalgus deformity, the patients were divided into 3 groups. Results. It was found that surgical treatment of mobile planovalgus deformity in children aged 7–11 years with cerebral palsy using techniques that are isolated aimed at correcting contractures and tendon-muscle balance of the ankle joint and foot is accompanied by a significant percentage of relapses (66.7 %). Additional use of a minimally invasive surgical technique for arthroereisis of the talocalcaneus joint allows improving the clinical and radiological results of surgical correction of mobile planovalgus deformity, but 80 % cases are accompanied by the development of chronic pain syndrome. In patients older than 12 years, it was clinically and radiographically confirmed the effectiveness of surgical treatment of mobile planovalgus deformity of a moderate and severe degree in children with cerebral palsy using corrective lateral lengthening osteotomy of the calcaneus bone. A hollow two-stage cone implant for arthroereisis has been developed and implemented to prevent the occurrence of pain syndrome, reduce the frequency of migrations and the need for repeated surgical interventions. The effectiveness of the developed implant for arthroereisis of the talocalcaneus joint has been proven during clinical testing. Conclusions. The developed algorithm of differentiated choice of surgical treatment methods for mobile planovalgus deformity in children with cerebral palsy, depending on age, level of gross motor functions and clinical characteristics of mobile planovalgus deformity, allows making a choice between minimally invasive techniques (arthroereisis, soft tissues surgery) and surgical interventions on the bones and joints of the foot (corrective lateral osteotomy of the calcaneus bone, arthrodesis of large joints of the posterior and middle compartments of the foot).
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