Cerebral palsy is a syndrome in which the lesion is located in the brain tissue and the main clinical manifestation is postural abnormalities and movement disorders. In addition to limb deformities, joint contractures, and motor dysfunction, children often have a variety of intellectual, linguistic, and life skills impairments. During the treatment, all related professionals, such as neurologists, pediatric orthopedic surgeons, anesthesiologists, kinesiologists, occupational therapists, speech therapists, orthopedic technicians, etc., should participate in the treatment, analyze the child’s various symptoms from different aspects, and propose a general treatment plan, so that the child can receive reasonable and comprehensive treatment and achieve good treatment results. The timing of cerebral palsy surgery When is it appropriate to perform surgical treatment for children with cerebral palsy? There have been different opinions. Some experts believe that children are growing individuals and their motor dysfunction, poor motor posture and habits, and poor gait will deteriorate rapidly as they grow, making treatment more difficult, so early orthopedic surgery is appropriate. Experts who disagree believe that early orthopedic surgery is preferable. Because children are growing and developing, early surgery is unstable, and deformities and movement disorders can recur and worsen, which is not only unhelpful but also harmful to the child. For example, children under the age of 14 have faster bone growth than muscle growth, so after tendon lengthening surgery, they are often prone to recurrence and need to be operated on again. In recent years, with the continuous progress of rehabilitation training technology and orthotic technology, coupled with the application of surgical therapy, it has become possible to ensure the effectiveness of surgery and control the recurrence of postoperative deformity. Therefore, the more consistent view is that surgery should be performed at the earliest possible time, supplemented by rehabilitation training and orthotic therapy, in order to achieve the best recovery of the child’s motor function. For children undergoing soft tissue surgery, the age of surgery is 5 years for lower extremity surgery and 7 years for upper extremity surgery. Children in this age group can effectively cooperate with the surgeon in the examination and training, thus ensuring the accuracy of surgical indications and surgical decisions and avoiding adverse consequences. Principles of surgical treatment for cerebral palsy (1) Relationship between the type of cerebral palsy and surgery: spastic cerebral palsy is most suitable for surgical treatment. (2) Neurological status and intelligence: The child should have good intelligence, IQ above 70%, desire for treatment, and be able to cooperate with rehabilitation after surgery. (3) Fixed limb deformity affecting rehabilitation training: If the child has been treated with regular rehabilitation training before surgery and has certain efficacy, but there is a deformity that is difficult to be corrected by manipulation and affects the improvement of motor function, surgery is appropriate to correct the deformity. (4)
Principles of upper limb surgery: the upper limb motor function is more complex, and more fine movements, the requirements for the treatment effect are higher, and it is hoped that the fine motor function of the hand can be restored. Therefore, it is more difficult to correct the deformity of the upper limb and restore the random motion function of the hand. It is required that the recipient of the upper limb, who should be of good intelligence, have a strong desire for rehabilitation, be able to actively train after surgery, and should have a certain degree of random motor function before surgery. (5)
Principles of treatment of polyarticular deformities of lower limbs: For children with multiple joint deformities of lower limbs such as hip, knee and ankle, each joint deformity should not be corrected at the same time. For example, hip flexion contracture or horseshoe foot can be followed by knee flexion changes, and knee flexion changes can often be improved after the primary deformity is corrected. Therefore, it is advisable to judge the primary deformity carefully before surgery and to correct it surgically, and to observe the adjacent joints closely for a period of time after surgery, depending on the changes, and then decide carefully whether follow-up surgery is necessary. (6) Accurate determination of the muscle strength of the spastic and antagonistic muscles: the muscle strength of the spastic deformity and its antagonistic muscles should be determined before surgery to make a correct judgment and design an accurate surgical plan. (7) Prevent complication of hip dislocation: If the child has strong hip inversion with a tendency of hip dislocation, it is advisable to perform early soft tissue release surgery on the medial hip to adjust the balance of muscle strength in order to prevent hip dislocation. (8)
Solve the difficulties of living care for children with severe cerebral palsy: children with severe cerebral palsy are unable to overcome limb deformities or postural abnormalities, which seriously affect their daily life. Those who have extreme difficulty in nursing care should have surgical orthopedics implemented to accommodate the needs of nursing care and life. For example, if both lower extremities are severely crossed and unable to care for urination and defecation, although there is no standing and walking after surgery, the cut of the adductor muscle should be performed in order to separate the legs and facilitate the care of completion of urination and defecation. (9)
Post-surgical rehabilitation: Cerebral palsy is very different from other orthopedic disorders, and the outcome after surgery is also very different. It is wrong to think that the surgery is completed successfully, and the recurrence of deformity in many children after surgery is a good illustration. In order to prevent postoperative recurrence and improve the therapeutic effect, postoperative rehabilitation and orthotic devices must be used. (10) Purpose of surgery: The main purpose of surgical treatment is to release muscle spasm, balance muscle strength, correct deformity, adjust the negative gravity line of the limb, and improve motor function.