Short-term and Long-term Clinical Results of the Surgical Correction of Thumb-in-Palm Deformity in Patients With Cerebral Palsy

作者：Alewijnse Juul V^*; Smeulders Mark J C; Kreulen Mick

来源：Journal of Pediatric Orthopaedics, 2015, 35(8): 825-830.

DOI：10.1097/bpo.0000000000000380

• spastic cerebral palsy
• hemiplegia
• thumb-in-palm deformity
• upper extremity surgery

Background: Thumb-in-palm deformity disturbs a functional grip of the hand in patients with cerebral palsy. Reported recurrence rates after surgical correction are contradicting and earlier studies are limited to short-term follow-up. Therefore, the aim of this retrospective clinical outcome study is to evaluate the success rate of surgical correction of thumb-in-palm deformity around 1 year and at a minimum of 5 years follow-up. In addition, long-term patient satisfaction of the treatment is evaluated.
Methods: Patients with cerebral palsy who underwent a surgical correction for their thumb-in-palm deformity between April 2003 and April 2008 at the Academic Medical Center in Amsterdam were included. All patients were classified into 4 categories according to the assessment system of the Committee on Spastic Hand Evaluation. The result of surgery was considered "short-term successful" and "long-term successful" when, respectively, short-term and long-term classification was better compared with preoperative. The association between the patient satisfaction outcomes and the long-term clinical outcomes were statistically analyzed.
Results: Data were collected from 39 patients and their charts. The success rate was 87% at short-term follow-up, which in the long term decreased to 80%. Interestingly, thumb position deteriorated in 29% of the patients between short-term and long-term follow-up. In the long term, 74% of the patients were satisfied with the position of their thumb and 87% would undergo the surgery again. Both these outcomes were statistically significant associated with the long-term success rate (P < 0.05).
Conclusions: The surgical correction of thumb-in-palm deformity has a high clinical success rate and patient satisfaction in the long term. However, it should be taken into account that the clinical result around 1 year postoperative cannot be considered final.

• 出版日期2015-12