Cerebral palsy presents stable encephalopathy that systemically
influences on the child's and adult's organism. Orthopedic
complications of cerebral palsy possess on the contrary progressive
features and those complications cause gradual failure of motor
ability of a person: impaired walking, loss of postural ability,
reduced self-care and inclusion, finally quality of life becoming
much worse. That is why orthopedic aspects are of great importance
in children with cerebral palsy. This volume presents a collection
of chapters covering a wide range of problems, from a system of
universal classification of dysfunctions in Cerebral Palsy and
practical issues of prevention of orthopedic complications
orthopedic to surgery (diagnostics and quantitative interpretation
of gait disorders in such patients, optimal methods of surgical
intervention, hip surgery, spinal surgery) and aspects of nutritive
status of this specific category of patients, associated
comorbidities and their influence and connection with orthopedic
problems. Furthermore, three chapters are dedicated to the
anesthetic aspects of orthopedic surgery. The substantiation is
given to the methods of combined anesthesia and sedation during
surgery, as well as in the immediate postoperative period, taking
into account concomitant epilepsy, increased intracranial pressure
and spasticity in such children. Single-event multilevel orthopedic
surgery is a recognized gold standard in ambulatory patients,
though it varies according to gait patterns and associated
orthopedic problems causing motor disorders. The book contains
explanations and methodology of surgeries for conventional gait
patterns, as well as in iatrogenic disorders caused by previous
unreasonable interventions. The chapter on the correction of
deformities and dysfunctions of the upper limb shows the first
applied transfer of m.flexor cubitus ulnaris to the radius, which
gave extremely positive results both in terms of function and
aesthetics. Unfortunately, in Russia the number of CP patients with
iatrogenic orthopedic disorders is high. Extremely negative
consequences in the form of weakness of the triceps muscles after
percutaneous fibromyotomies (so-called "Ulzibat method") or
lengthening of the Achilles tendon in diplegia performed before the
age of five years and before the development of muscle retraction
lead to the development of crouch gait even in patients with high
motor potential (GMFCS I, II). This complication of unreasonable
surgical interventions develops in 5-7 years after primary surgery
and in the opinion of doctors and parents is not related to
previous procedures. This book, based on 3D-instrumented gait
analysis, shows the features of iatrogenic crouch gait, as well as
methods of surgical correction of this difficult situation. The
data presented in this book are based, on the one hand, on the
personal practical and scientific experience of each author, and on
the other hand, the entire team of authors works in collaboration
with each other, coordinating their decisions and interventions
with colleagues, thus ensuring continuity in treatment of children
and adults suffering from cerebral palsy.
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