J Korean Orthop Assoc.  2007 Dec;42(6):711-717. 10.4055/jkoa.2007.42.6.711.

Bilateral Femoral Derotatioal Osteotomy in Spastic Diplegia: Outcome Assessment of Single Stage Multilevel Surgery

• Chung CY
• Park MS
• Song BW
• Choi IH
• Cho TJ
• Yoo WJ

• KMID: 1947775
• DOI: http://doi.org/10.4055/jkoa.2007.42.6.711

Abstract

PURPOSE: To evaluate the outcome of multilevel surgery including femoral derotational osteotomy, and analyze the effect of bilateral femoral derotational osteotomy on the gait of spastic diplegia.
MATERIALS AND METHODS
The medical records of 26 spastic diplegics, who had undergone a bilateral intertrochanteric femoral derotational osteotomy, bilateral distal hamstring lengthening, bilateral rectus femoris transfer, and bilateral heel cord lengthening, were evaluated. There were 16 boys and 10 girls with a mean age of 7.6 years. The pre- and post-operative gait analysis, functional assessment score, and physical examination were archived and analyzed.
RESULTS
In the physical examination, the femoral anteversion, hip flexion contracture, and popliteal angle decreased significantly, while the ankle range of dorsiflexion increased significantly. In three dimensional gait analysis, the cadence remained constant while the walking speed improved significantly. In transverse plane kinematics, the mean pelvic rotation did not show any difference but foot progression angle fell into the normal range after surgery. In the sagittal plane, the maximal hip extension and H3 power generation improved significantly, while the mean anterior pelvic tilt decreased significantly. The functional assessment score improved from 7 to 9, which was significant.
CONCLUSION
The walking ability of spastic diplegia with in-toeing, stiff knee and tip toeing gait improved after single stage multilevel surgery including a femoral derotational osteotomy. Femoral derotation osteotomy without psoas lengthening improved the anterior pelvic tilt despite the distal hamstring lengthening

Keyword

Cerebral palsy; Spastic diplegia; Torsional deformity; Gait pattern; Femoral derotational osteotomy

MeSH Terms

Ankle
Biomechanical Phenomena
Cerebral Palsy*
Contracture
Female
Foot
Gait
Heel
Hip
Humans
Knee
Medical Records
Muscle Spasticity*
Osteotomy*
Physical Examination
Quadriceps Muscle
Reference Values
Toes
Walking

Figure

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  Fig. 1 Spastic diplegic patient with bilateral in-toeing, stiff knee and tip toeing gait.

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  Fig. 2 Functional Assessment Questionnaire in Korean.

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  Fig. 3 Graphs showing the pre- and post-operative changes in the foot progression angle (—— pre, …… post, ---- normal).

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  Fig. 4 Graphs showing the pre- and post-operative changes in the anterior pelvic tilt (—— pre, …… post, ---- normal).

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  Fig. 5 Graphs showing the pre- and post-operative changes in the maximal hip extension (—— pre, …… post, ---- normal).

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