DOI: https://doi.org/10.22141/1608-1706.3.17.2016.75785

Functionality of Lower Limbs in Patients with Orthopedic Manifestations of Spinal Dysraрhism

Yu.M. Huk, A.I. Cheverda, T.M. Seker, T.A. Kincha-Polishchuk, Yu.M. Shkurko, A.V. Zotia

Abstract


Spinal dysraрhism is an important cause of static-locomotor disorders in children. Injuries of varying degrees of paralysis or paresis of the lower limbs, dysfunction of the pelvic organs, limbs and spine deformation, which significantly affects the quality of life and ability to movement and maintenance depends on the level of spinal cord lesion. Objective. To assess the ability to move in patients with the consequences of open forms of spinal dysraрhism, depending on the level of functional insufficiency of the lower limbs. Materials and methods. Material of the study were 81 patients aged from 5 to 21 years old (average age was 10 years and 8 months olg), 69 patients experienced paraparesis of the lower extremities, 12 — monoparesis. To determine the level of spinal cord lesion we used Sharrard’s (1964) as modified Bartonek et al. (1999) classification. Ability to move was evaluated by Hoffer et al. (1973) classification. Results and discussion. All patients included in the study are distributed according to the level of functional muscular strength into five clinical groups with a certain level of functional muscular strength by Sharrard’s classification (1964) with Bartonek modification (1999) and estimated actual degree of movement in the patients by Hoffer’s classification. Comparing the actual degree of movement in groups of patients to the theoretically expected degree of movement of patients it was conducted that children with the same level of functional insufficiency of the lower limbs do not always achieve the expected degree of movement, and it depends on the confounding factors such as intellectual (mental) level of a child, the progression of hydrocephalus, obesity, severity of orthopedic pathology, presence of spasticity that impact a degree of movement. Conclusions. The level of the spinal cord lesion that determines the level of muscle function of the lower limbs is an important factor in the ability of patients to move in comorbid spinal dysraphism. Patients with the same level of loss of the muscle function does not always achieve the expected level of movement.


Keywords


spinal dysraphism; lower limbs; paralysis; paresis; muscle strength

References


Abraham E. Supramalleolar osteotomy for ankle valgus in myelomeningocele / E. Abraham, J.P. Lubicky, M.N. Songer, E.A. Millar // J. Ped. Orthop. — 1996. — Vol. 16. — P. 774-781.

Akar Z. Myelomeningocele / Z. Akar // Surg. Neural. — 1995. — Vol. 43. — P. 113-118.

Alexiou G.A. Cerebral abnormalities in infants with myelomeningocele / G.A. Alexiou, M.K. Zarifi, G. Georgoulis et al. // Neurol. Neurochir. Pol. — 2011. — Vol. 45. — P. 18-23.

Asher M. Factors affecting the ambulatory status of patients with spina bifida cystica / M. Asher, J. Olson // J. Bone Joint Surg. — 1983. — Vol. 65-A. — P. 350-356.

Banta J.V. Long-term ambulation in spina bifida / J.V. Banta, J.M. Casey, L. Bedell, J. Morgan // Devel. Med. Child Neurol. — 1983. — Vol. 25. — P. 110.

Bartonek A. Ambulation in patients with myelomeningocele: a 12-year follow-up / A. Bartonek, H. Saraste, L. Samuelsson, M. Skoog // J. Ped. Orthop. — 1999. — Vol. 19. — P. 202-206.

Bartonek A. Factors influencing ambulation in myelomeningocele: a cross-sectional study / A. Bartonek, H. Saraste // Dev. Med. Child Neurol. — 2001. — Vol. 43. — P. 253-260.

Broughton N.S. The high incidence of foot deformity in patients with high-level spina bifida / N.S. Broughton, G. Graham, M.M. Menelaus // J. Bone Joint Surg. — 1994. — Vol. 76-B. — P. 548-550.

Correll J. The effect of soft tissue release of the hips on walking in myelomeningocele / J. Correll, C. Gabler // J. Ped. Orthop. — 2000. — Vol. 9-B. — P. 148-153.

Doran P.A. Studies in spina bifida cystica: I general survey and reassessment of the problem / P.A. Doran, A.N. Guthkelch // J. Neurol. Neurosurg. Psychiatry. — 1961. — Vol. 24. — P. 331-345.

Fletcher J.M. Spinal lesion level in spina bifida: a source of neural and cognitive heterogeneity / J.M. Fletcher, K. Copeland, J.A. Frederick et al. // J. Neurosurg. — 2005. — Vol. 102 (Suppl. 3). — P. 268-279.

Hoffer M.M. Functional ambulation in patients with myelomeningocele / M.M. Hoffer, E. Feiwell, R. Perry et al. // J. Bone Joint Surg. — 1973. — Vol. 55-A. — P. 137-148.

Huff C.W. Myelodysplasia / C.W. Huff, P.L. Ramsey, M.D. Wilmington // J. Bone Joint Surg. — 1978. — Vol. 60-A. — P. 432-443.

Lee E.H. Hip stability and ambulatory status in myelomeningocele / E.H. Lee, N.C. Carroll // J. Ped. Orthop. — 1985. — Vol. 5. — P. 522-527.

Lew S.M. Tethered cord syndrome: an updated review / S.M. Lew, K.F. Kothbauer // Pediatr. Neurosurg. — 2007. — Vol. 43(3). — P. 236-248.

Lindseth R.E. Myelomeningocele / R.E. Lindseth, L.S. Dias, J.C. Drennan // Instr. Course Lect. — 1991. — Vol. 40. — P. 271-291.

Marshall P.D. Surgical release of knee flexion contractures in myelomeningocele / P.D. Marshall, N.S. Broughton, M.B. Menelaus, H.K. Graham // J. Bone Joint Surg. — 1996. — Vol. 78-B. — P. 912-916.

Mazur J.M. Neurologic status of spina bifida patients and the orthopedic surgeon / J.M. Mazur, M.B. Menelaus // Clin. Orthop. Relat. Research. — 1991. — Vol. 264. — P. 4-64.

McDonald C.M. Ambulatory outcome of children with myelomeningocele: effect of lower-extremity muscle strength / C.M. McDonald, K.M. Jaffe, V.S. Mosca, D.B. Shurtleff // Devel. Med. Child Neurol. — 1991. — Vol. 33. — P. 482-490.

McDonald C.M. Assessment of muscle strength in children with myelomeningocele: accuracy and stability of measurements over time / C.M. McDonald, K.M. Jaffe, D.B. Shurtleff // Arch. Phys. Med. Rehabil. — 1986. — Vol. 67. — P. 855-861.

Northrup H., Volcik K.A. Spina bifida and other neural tube defects / H. Northrup, K.A. Volcik // Curr. Probl. Pediatr. — 2000. — Vol. 30. — P. 313-332.

Phillips D.L. Reciprocating orthoses for children with myelomeningocele. A comparison of two types / D.L. Phillips, R.E. Field, N.S. Broughton et al. // J. Bone Joint Surg. — 1995. — Vol. 77-B. — P. 110-113.

Rengasamy P. Etiology, pathogenesis and prevention of neural tube defects / P. Rengasamy // Cong. Anomal. — 2006. — Vol. 46. — P. 55-67.

Samuelsson L. Ambulation in patients with myelomeningocele: a multivariate statistical analysis / L. Samuelsson, M. Skoog // J. Ped. Orthop. — 1988. — Vol. 8. — P. 569-575.

Sharrard W.J.W. The segmental innervation of the lower limb muscles in man / W.J.W. Sharrard // An. Royal Coll. Surg. — 1964. — Vol. 35. — P. 106-122.

Swaroop V.T. Orthopaedic management of spina bifida. Part I: hip, knee and rotational deformities / V.T. Swaroop, L.S. Dias // J. Child. Orthop. — 2009. — Vol. 3. — P. 441-449.

Swaroop V.T. Orthopaedic management of spina bifida. Part II: foot and ankle deformities / V.T. Swaroop, L. Dias // J. Child. Orthop. — 2011. — Vol. 5. — P. 403-414.

Vachha B. Limbic tract anomalies in pediatric myelomeningocele and Chiari II malformation: anatomic correlations with memory and learning — initial investigation / B. Vachha, R.C. Adams, N.K. Rollins // Radiology. — 2006. — Vol. 240. — P. 194-202.




Copyright (c) 2016 TRAUMA

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2019

 

   Seo анализ сайта