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ACTUAL DIRECTIONS OF THE OPTIMIZATION OF THE SURGICAL TREATMENT OF LOCOMOTOR DISORDERS IN SPASTIC FORMS OF INFANTILE CEREBRAL PALSY


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Abstract

The review of actual directions of optimization of surgical treatment of locomotor disorders in spastic forms of infantile cerebral palsy is presented. When choosing the tactics of the treatment for this category of patients, the following criteria should be taken into account: the degree of disturbances in motor activity associated with muscle tone disorders, the spasticity pattern, the presence of joint contractures, limb deformities, the level of intellectual development, the presence and severity of perceptual disorders. The implementation of simultaneous operations allows reducing the period of immobilization of the child and the period of temporary incapacity for work of parents and recommended for the treatment of patients with cerebral palsy at all levels of the Gross Motor Function Classification System (GMFCS). There are considered modern methods of surgical treatment of spastic instability of the hip when the choice of the method of correction of the acetabular component of instability depends on the degree of abnormalities of the anatomy of the acetabulum, mainly from the deficit of the bone covering of the head of the femur and the «slanting» of the roof of the acetabulum. In the treatment of contractures of knee joints in order to prevent сrush syndrome, the elongation of the medial group of tibial flexors is advisable to be used in conjunction with tonus-enhancing operations in the anterior group of femur muscles with their secondary weakness. When treating axial deformities of the knee joints and unequal length of the legs, it is important to observe the timeliness principle (during the active growth of the skeleton) with the use of minimally invasive surgical interventions - hemi and epiphysiodesis - to avoid the need for more traumatic interventions.


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