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Master Thesis

Neurectomies hypersélectives dans le traitement de la spasticité au membre supérieur de l’adulte et de l’enfant

Abstract : Objective. The objective of this stufywas to assess the short term, mid-term and long term outcome of hyperselective neurectomy (HSN) in upper limb spasticity in adults and children. Material and Methods. Fourty eight patients having upper limb spasticity (30 men, 18 women) with age ranging from 7,3 to 74,5 (mean 32,31) years were assessed using Modified Ashworth Scale (MAS), Modified Tardieu Scale, and House Scale, clinical range of motion and muscle testing, preoperatively (preop), at 6 months postoperatively (postop) and at last follow up. A subjective assessment was done at the last follow up by the patient. Results. Seventy-four HSN were realised : 4 for the shoulder, 34 for elbow flexors, 14 for pronators of the fore-arm, 21 for wrist flexors and one for the hand. Associated surgeries were more often tendon lengthening (34 cases) and tenotomies (4 cases). Average increase in active range of motion was, for the elbow, 16,5° at 6 months postop and 13,9° at last follow-up ; for pronosupination it was 14,3° at 6 months postop and 21,1° at last follow-up ; for the wrist it was 5,0° at 6 months postop and 18,3° at last follow-up. Analysis using bayesian methods showed a increase in the House Scale at 6 months postoperatively of 1,10 [0,52-1,69], Pr(>0)=99,99\%, and at last follow up of 1,49 [0,92-2,06], Pr(>0)=99,99\%. Concerning elbow flexors, MAS decreased at postop compared to preop of 0,81 [-1,17 ;-0,47], Pr(<0)=99,99% and at last follow up of 0,63 [-1,06 ;-0,27], Pr(<0)=99,99%. Concerning pronators, MAS decreased at postop compared to preop of 0,48 [-0,77 ;-0,27], Pr(>0)=0,0% and at last follow up of 0,33 [-0,61 ;-0,03], Pr(>0)=1,0%. Concerning wrist flexors, MAS decreased at postop compared to preop of 0,97 [-1,29 ;-0,67], Pr(>0)=2,2% and at last follow up of 0,75 [-0,14 ; 0,002], Pr(>0)=0,1%. Average patient satisfaction was 8,56. Conclusion. HSN is an efficacious surgical intervention in the treatment of upper limb spasticity. It is apparently beneficial in the reduction of spasticity, amelioration of functional status, facilitation of patient care and prevention of musculoskeletal deformities.
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Master Thesis
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Submitted on : Wednesday, October 3, 2018 - 11:35:32 AM
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Anne Perruisseau-Carrier. Neurectomies hypersélectives dans le traitement de la spasticité au membre supérieur de l’adulte et de l’enfant. Médecine humaine et pathologie. 2018. ⟨dumas-01886833⟩

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