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Long term outcome of SEMLS including DHL in spastic diplegia

Long term outcome of SEMLS including DHL in spastic diplegia. Ki Hyuk Sung, MD Department of Orthopaedic Surgery Seoul National University Bundang Hospital. Introduction. Distal hamstring lengthening (DHL) commonly performed procedure in flexed knee gait

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Long term outcome of SEMLS including DHL in spastic diplegia

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  1. Long term outcome of SEMLS including DHL in spastic diplegia Ki Hyuk Sung, MD Department of Orthopaedic Surgery Seoul National University Bundang Hospital

  2. Introduction • Distal hamstring lengthening (DHL) • commonly performed procedure in flexed knee gait • Effective at reducing knee flexion and improving knee motion • Concern on adverse effect ( increased pelvic tilt, lumbar hyperlordosis, genu recurvatum, crouch gait) in long term follow up

  3. Introduction • Few studies about the long-term effects of SEMLS with DHL in spastic diplegia. • It is questionable whether functional improvements after surgery are maintained into adulthood. • It is questionable how long improvements last.

  4. Purpose • To investigate the long term outcome of SEMLS including DHL in patients with CP (GMFCS level I-III) • Focus on the kinematic changes

  5. Material and methods

  6. Inclusion criteria • Ambulatory patients with spastic diplegic cerebral palsy (GMFCS level I-III) • Patients who underwent SEMLS including bilateral DHL • Patients who had preoperative, 1-year postoperative, and 10-year postoperative 3D gait analysis

  7. Exclusion criteria • Concurrent neuromuscular disease • History of gait correcting surgery • History of dorsal rhizotomy

  8. Operative protocols • Single event multilevel surgery by one surgeon • Base on both clinical and gait analysis findings • Standard postsurgical care including casting or bracing

  9. Surgical principles of procedures

  10. Acquisition of data • 3D gait analysis • Preoperative • 1 year postoperative • Over 10 year postoperative • Kinematic parameter, temporal parameter, GDI • Comparison using repeated measures analysis of variance (ANOVA) with a Boneferroni post hoc test

  11. GDI (gait deviation index) • Represent overall gait pathology • Correlated with GGI, FAQ, GMFM • Pelvic and hip kinematic data in three plane, knee and ankle data in sagittal plane, and foot progression • GDI score≥100 denote a non-pathological gait

  12. Results

  13. Dermographics and preop P/Ex

  14. Summary of surgical procedures

  15. Temporal parameters after SEMLS

  16. Pelvis and hip Kinematic parameters

  17. Knee kinematic parameters

  18. Ankle and foot kinematic parameters

  19. GDI after SEMLS

  20. Conclusion • SEMLS including DHL provides favorable outcomes 10 years postoperatively in patient with spastic diplegic cerebral palsy • DHL is an effective procedure in flexed knee gait without increasing pelvic tilt • Considerable risk of equinus deformity recurrence should be taken into consideration

  21. Thank you for your attention!

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