Clin Orthop Surg.  2016 Jun;8(2):187-193. 10.4055/cios.2016.8.2.187.

Effects of Soft Tissue Surgery on Pelvic and Hip Rotation in Patients with Spastic Diplegia: A Meta-Analysis

• Jung HJ
• Yoon JY
• Oh MK
• Kim YC
• Kim JH
• Eom TW
• Park KB

• KMID: 2412345
• DOI: http://doi.org/10.4055/cios.2016.8.2.187

Abstract

BACKGROUND
There are several different opinions regarding the improvements seen on the transverse plane after soft tissue surgery alone in independently ambulant patients with cerebral palsy. We performed a meta-analysis using data from previous studies to identify the effects of soft tissue surgery alone on pelvic and hip rotation in children with spastic diplegia.
METHODS
We conducted a pilot study to evaluate the improvement in pelvic and hip rotation after muscle-tendon lengthening surgery in children with spastic diplegia. We also searched EMBASE and PubMed and selected 2 previous studies using the same test conditions with kinematic data on the pelvis and hip joints. A meta-analysis of the results of these 3 studies, including this pilot study, was then performed.
RESULTS
The meta-analysis results showed an external rotation decrease (p = 0.005) in the mean difference of pelvic rotation of -3.61 (95% confidence interval [CI], -6.13 to -1.09) and a mean difference in hip rotation of 6.60 (95% CI, 3.34 to 9.86), indicating a significant increase in the hip external rotation after surgery (p < 0.001).
CONCLUSIONS
In independently community-ambulant pediatric patients with spastic diplegia, pelvic retraction and hip internal rotation could be improved after soft tissue surgery.

Keyword

Cerebral palsy; Pelvis; Hip; Rotation

MeSH Terms

Adolescent
Cerebral Palsy/physiopathology/*surgery
Child
Female
Hip/*surgery
Humans
Male
Orthopedic Procedures/*statistics & numerical data
Pelvis/*surgery
Pilot Projects
Range of Motion, Articular/*physiology

Figure

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  Fig. 1 Systematic search strategy results.

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  Fig. 2 Pelvic and hip motion in transverse plane during gait in our pilot study. (A) Preoperative pelvic rotation, (B) postoperative pelvic rotation, (C) preoperative hip rotation, and (D) postoperative hip rotation.

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  Fig. 3 Meta-analysis of the effect of soft tissue surgery on pelvic rotation (A) and hip rotation (B) in pediatric patients with spastic diplegia. MD: mean difference, CI: confidence interval.

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