[Percutaneous tenotomy and aponeurotomy (PTA) for knee flexor contracture in children with spastic cerebral palsy]. / Tenotomía y aponeurotomía percutánea (TAP) para la contractura de los flexores de rodilla en niños con parálisis cerebral espástica.

UNLABELLED: Knee flexor muscle contracture is frequent in patients with spastic cerebral palsy. The purpose of the study was to determine whether percutaneous tenotomy and aponeurotomy may decrease knee flexor contracture in children with spastic cerebral palsy. MATERIAL AND METHODS: A prospective study of consecutive cases was conducted from January to December 2009 in 24 children with a diagnosis of moderate to severe spastic cerebral palsy who had knee flexor contracture with a popliteal angle > or = 45 degrees and a gross motor function classification scale of 4 or 5; they underwent percutaneous tenotomy and aponeurotomy surgery and were followed-up for 24 months. Variance analysis with a factorial design was used for data analysis. RESULTS: The mean popliteal angle was 83.48 degrees preoperatively and 27.30 degrees by the end of the follow-up, with an improvement of 56.18 degrees (p < 0.01). Statistically significant differences were found in all measurements comparing them with the baseline values. DISCUSSION: Percutaneous aponeurotomy of knee flexor muscles is described. Compared to other procedures it provides the benefits of minimally invasive surgery, mild postoperative pain, short hospital stay -without using immobilization during the entire process- and children returned to their therapy program within five days. CONCLUSION: Percutaneous tenotomy and aponeurotomy of knee flexors was shown to be a good alternative for the treatment of knee flexor contracture in patients with spastic cerebral palsy.

Factores de riesgo en niños con parálisis cerebral infantil en el Centro de Rehabilitación Infantil Teletón, Estado de México / Risk factors in children with infantile cerebral palsy in the Infantile Rehabilitation Center Teleton, Mexico

Introducción. Durante el período madurativo del sistema nervioso central pueden ocurrir riesgos que provoquen lesión cerebral en el período intrauterino, en el momento de nacer o después. Objetivo. Conocer los factores de riesgo en pacientes con diagnóstico de parálisis cerebral infantil del Centro de Rehabilitación Infantil Teletón, Estado de México y su frecuencia. Material y métodos. Estudio observacional, retrospectivo. Se revisaron historias clínicas de pacientes de ambos sexos buscando factores de riesgo. Los resultados se analizaron con pruebas estadísticas de tasa, razón y proporción. Resultados. De 1.112 historias clínicas de pacientes con daño neurológico, 773 tuvieron parálisis cerebral, 653 pacientes con factores de riesgo prenatales y natales, y sólo 120 con factores de riesgo posnatal. El factor de riesgo más frecuente en la etapa prenatal fue la ruptura prematura de membranas, en la etapa natal el período expulsivo prolongado y en la etapa posnatal la neuroinfección. El 42,83 % de los niños pertenecía a la primera gestación. Conclusión. La mayoría de los pacientes fueron varones, los riesgos se presentaron en el tercer trimestre del embarazo y en el momento del parto, la edad de los padres influyó poco en el diagnóstico y la puntuación de Apgar no fue parámetro para el daño

Introduction. During the central nervous system maturation period, there may be risks that cause brain lesion in the intrauterine period, at birth or afterwards. Objective. Know the risk factors in children with cerebral palsy in the Rehabilitation Center Teleton, Mexico and its frequency. Material and methods. This is an observational, retrospective study. The clinical histories of the patients of both genders were reviewed, seeking risk factors. The results were analyzed with statistical tests of rates, odds ratio and proportion. Outcomes. A total of 773 out of 1112 patients with brain damage had cerebral palsy: 653 with prenatal and natal risks factors and only 120 with postnatal risk factors. The most frequent prenatal risk factor was premature rupture of the membrane, prolonged labor period at birth and neuroinfection in the postnatal period. A total of 42.83 % of the children belonged to the first pregnancy. Conclusion. Most of the patients were male, the risk occurred in the last quarter of the pregnancy and at birth. The parents' age had little influence on the diagnosis and Apgar score was not a parameter for damage