Preliminary Study On Surgical Treatment Strategy For Upper Limbs Dysfunction Of Cerebral Palsy

Objective: The aims of this study were to retrospectively analyze the postoperative improvement of upper limb dysfunction in patients with cerebral palsy,preliminarily study the surgical treatment strategies and indications for upper limb dysfunction in patients with cerebral palsy,and systematically summarize the treatment methods,so as to provide a basis for the surgical treatment of upper limb dysfunction in patients with cerebral palsy.Methods: Retrospective study of 31 patients with cerebral palsy upper limb dysfunction who underwent surgical treatment in our department from January2012 to August 2019 and were followed up,and 19 patients are still being followed-up,including 12 males and 7 females,the age of the first operation was4-36 years old,with an average age of(18.3 ± 9.1)years old.All patients were treated with different methods of surgical treatment for upper limb dysfunction,including peripheral nerve surgery and orthopedic surgery.The number of cases of each type of operation,operation times and its curative effect were counted.The Fugl–Meyer Upper Limb Motor Function Scale(FMA),House Hand Function Rate,and Modified Ashworth Spasm Scale were used to evaluate the efficacy before and the last follow-up.The differences in efficacy between different levels were compared according to the MACS classification.The visual analog scale(VAS)was used to quantitatively evaluate the satisfaction of patients or caregivers with the efficacy.Results: There are 19 patients are still being followed up for an average followup time of 28.4(6-78)months,and 14 patients were followed up for at least 1 year.A total of 27 surgeries were performed,of which 13 were performed once,5 were performed twice,and 1 was performed four times,involving a total of 24 limbs.Among them,10 patients underwent orthopedic surgery alone,6 patients underwent peripheral nerve surgery alone,and 3 patients underwent orthopedic surgery plus peripheral nerve surgery.At the last follow-up,the FMA score increased by an average of(8.47 ± 2.53)points before the surgery,and the difference between before and after the comparison was statistically significant(P<0.05).At the last follow-up,House hand functional grade increased by an average of 2.3,and the difference between before and after the comparison was statistically significant(P <0.05).There was no significant difference in FMA score and House hand function grade before and after surgery between different MACS levels.In 9 patients undergoing peripheral nerve surgery,the muscle tone of the upper limb muscle group decreased by an average of 0.48 at the last followup,and there was a significant difference in MAS quantitative score before and after surgery(P <0.05).The average satisfaction score of patients or caregivers for the efficacy was 6.74(4-10).Conclusion: Surgery is a reliable and effective way to treat upper limb dysfunction of cerebral palsy.When rehabilitation training enters the bottleneck stage,the intervention of surgery is necessary.