Cirugía multinivel en pacientes adultos con diplejía espástica, resultados anátomo-funcionales

Abstract

Objective: To demonstrate the anatomical and functional results of the gait pattern in a patient suffering from cerebral palsy who underwent surgery with multilevel surgery in adulthood, after evaluation by a specialized gait rehabilitator.
Materials and methods: A clinical case report of a patient sometimes undergoing multilevel surgery in February 2016 with a diagnosis of adult cerebral palsy, with functional alteration in the gait pattern, was carried out. A protocol was carried out that divided into five phases: general preoperative, physiatric preoperative, surgical, postoperative, and one-year follow-up. Performing observational analysis of gait after completing 12 months of the surgical procedure, stability and muscle strength using the Denis scale and satisfaction survey.
Results: The dynamic range during gait cycles finds that multilevel surgery provides an upright standing position, the mayor stability in its support base that can improve gait, exceeding 50 meters away. The maximum mean knee flexion value was not improved in the non-support phase. The values collected in the sagittal plane of the ankle do not have specific differences either. In the satisfaction questionnaire used, it records a result of 78%.
Conclusions: Multilevel osteomuscular surgery achieved improvements in both the technical, functional and patient satisfaction aspects. The analysis of movement is part of the diagnostic approach evaluated, the quantitative and qualitative measurement of gait, both pre and post-surgical. Hip extension, knee and equine foot correction; in the support phase, it was the result of adequate surgical procedures and an adequate rehabilitation program. There are few changes regarding kinematic values of the non- support phase, possibly due to inconveniences in flexion-extension and degrees of muscular strength. Nutritional support in extensive surgeries such as multilevel surgery is key in the post-surgical phase, which helps to regain your lost muscle strength in surgical trauma and on rest days.