Child's Nervous System ( IF 1.4 ) Pub Date : 2021-01-02 , DOI: 10.1007/s00381-020-05018-2 Patricia Mortenson 1, 2 , Nishanth Sadashiva 3 , Mandeep S Tamber 4 , Paul Steinbok 4
Purpose
In children with spastic cerebral palsy, selective dorsal rhizotomy (SDR) is conducted to improve lower limb spasticity. Improvements in upper extremity function have also been noted in early follow-up. The purpose of this study was to determine if upper extremity improvements are sustained in the long term.
Methods
A retrospective review of prospectively collected data on children who underwent SDR was conducted. Quality of Upper Extremities Skill Test (QUEST) scores for dissociated movement, grasp and total scores were compared using repeated measures ANOVA for individual patients at three time points: preoperatively, early post-operatively (≤ 2 years) and late post-operatively (9+ years).
Results
Out of 200+ patients having SDR, 32 had QUEST assessment at all three time points. Significant improvements in QUEST dissociated movement (F = 3.665, p = 0.045), grasp (F = 7.995, p = 0.001) and total scores (F = 9.471, p = 0.001) were found. Pairwise comparisons were significant from pre-operative to early post-operative times for all QUEST scores (p = 0.001, 0.003, 0.001), and this was maintained at late post-operative assessment for grasp and total scores (p = 0.02, p = 0.02). There was no significant change in scores between early and late post-operative assessment time points.
Conclusion
Early improvements in upper extremity QUEST total scores are sustained in the long term following SDR.
中文翻译:
脑性瘫痪儿童选择性脊神经背根切断术后长期上肢表现
目的
对于痉挛性脑瘫患儿,进行选择性背根切断术(SDR)以改善下肢痉挛状态。在早期随访中也注意到上肢功能的改善。本研究的目的是确定上肢改善是否能长期持续。
方法
对接受 SDR 的儿童前瞻性收集的数据进行了回顾性审查。使用重复测量方差分析在三个时间点对个别患者进行了上肢技能测试(QUEST)分离运动、抓握和总分的质量比较:术前、术后早期(≤ 2 年)和术后晚期(9 + 年)。
结果
在 200 多名患有 SDR 的患者中,32 名在所有三个时间点都进行了 QUEST 评估。发现 QUEST 分离运动(F = 3.665,p = 0.045)、抓握(F = 7.995,p = 0.001)和总分(F = 9.471,p = 0.001)的显着改善。对于所有 QUEST 评分(p = 0.001、0.003、0.001),从术前到术后早期的成对比较是显着的,并且在术后后期评估掌握和总分时保持这一点(p = 0.02,p = 0.02)。术后早期和晚期评估时间点之间的评分没有显着变化。
结论
在 SDR 之后,上肢 QUEST 总分的早期改善在长期内得以持续。