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Tugas Akhir
FAKTOR – FAKTOR YANG MEMPENGARUHI SKOR
FUNGSIONAL ANKLE PADA PASIEN CEREBRAL PALSY
SPASTIK DIPLEGIA YANG TELAH DILAKUKAN SINGLE
EVENT MULTI LEVEL SURGERY
DI RSO. PROF. DR. R. SOEHARSO SURAKARTA

Disusun oleh:
Aryo Budiyogo Andryanto

Pembimbing:
dr Anung Budi Satriadi SpOT (K)
dr Mujaddid Idulhaq SpOT (K)

Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret

University-
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Prof.Dr.dr.R.Soeharso Orthopaedic Hospital,Solo
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FAKTOR – FAKTOR YANG MEMPENGARUHI SKOR FUNGSIONAL

ANKLE PADA PASIEN CEREBRAL PALSY SPASTIK DIPLEGIA YANG
TELAH DILAKUKAN SINGLE EVENT MULTI LEVEL SURGERY
DI RSO. PROF. DR. R. SOEHARSO SURAKARTA
(Final Paper)
Aryo Budiyogo Andryanto

Abstrak

Latar Belakang. Single Event Multi Level Surgery (SEMLS) merupakan penanganan
yang paling sering digunakan untuk memperbaiki deformitas dan fungsional pada anak
dengan Cerebral Palsy (CP) Spastik Diplegia. Belum ada penelitian di Indonesia yang
menilai fungsi ankle pada pasien CP Spastik Diplegia yang telah dilakukan SEMLS.
Tujuan penelitian ini adalah mengetahui pengaruh faktor umur, jenis kelamin dan
jangka waktu operasi SEMLS dengan fungsional ankle pasien – pasien CP Spastik
Diplegia yang telah dilakukan SEMLS di RSO. Prof. Dr. R. Soeharso Surakarta (RSO).

Metode. Penelitian ini merupakan studi cross sectional pada 43 pasien (25 laki-laki
dan 18 perempuan) penderita Cerebral Palsy Spastik Diplegia yang telah dilakukan
SEMLS di klinik pediatric orthopaedi RSO. Prof.dr.R.Soeharso Surakarta minimal 3
bulan pasca operasi, sejak 1 Januari 2013 hingga 31 Desember 2014. Fungsi ankle
dinilai dengan The Oxford Ankle Foot Quissionairre for Children. outcome dalam
prosentase di kelompokkan menjadi 4 : 91% - 100 % sangat baik, 81% - 90 % baik, 71
% - 80 % cukup dan jika lebih kecil dari 70% kurang. Kemudian dilakukan penilaian
pengaruh umur, jenis kelamin dan lamanya evaluasi pasca operasi terhadap skor
fungsional ankle pasien dengan pemeriksaan analisa model regresi linier.

Hasil: Didapatkan 52 pasien dengan CP Spastik Diplegia telah dilakukan SEMLS

namun hanya 43 pasien yang memenuhi kriteria inklusi, pasien termuda berusia 5
tahun dan tertua 15 tahun dengan rerata usia 8,3 tahun. Dari 43 pasien, 25 orang (58
%) adalah laki – laki dan 18 orang (42%) adalah perempuanlamanya evaluasi paska
operasi paling cepat adalah 5 bulan dan terlama adalah 26 bulan dengan rerata 14,3
bulan pasca operasi SEMLS. Dari 43 pasien didapatkan 11 pasien (25 %) fungsinya
istimewa, 21 pasien (49%) baik, 8 pasien (19%) cukup, dan 3 (7 %) kurang. Faktor
umur berpengaruh secara signifikan terhadap skor fungsional ankle (p =0,013) dan
faktor lamanya evaluasi paska operasi juga berpengaruh secara signifikan terhadap
skor fungsional Ankle dengan nilai p=0,04. Sedangkan jenis kelamin tidak
berpengaruh terhadap skor fungsional ankle (p= 0,266).

Kesimpulan. Didapatkan hasil yang cukup baik dalam penanganan pasien CP Spastik
Diplegik yang dilakukan SEMLS di RSO. Prof. Dr. R. Soeharso. Umur dan lamanya
evaluasi paska operasi berpengaruh secara signifikan terhadap skor fungsional ankle
pada pasien CP Spatik Diplegia yang telah dilakukan SEMLS. Sedangkan jenis
kelamin pasien tidak berpengaruh terhadap skor fungsional ankle pada pasien CP
Spastik Diplegia yang telah dilakukan SEMLS.
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Kata Kunci : RSO. Prof. Dr. R. Soeharso user CP Spastik Diplegia, SEMLS,
Skor Fungsional Ankle

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FACTORS AFFECTING THE SCORES IN FUNCTIONAL ANKLE

SPASTIC DIPLEGIA CEREBRAL PALSY PATIENTS THAT HAVE BEEN
PERFORMED SINGLE EVENT MULTI LEVEL SURGERY
AT RSO. PROF. DR. R. SOEHARSO SURAKARTA
(Final Paper)
Aryo Budiyogo Andryanto

Abstract

Background: Single Event Multi Level Surgery (SEMLS) is the treatment most often
used to correct deformities and functional in children with Spastic Diplegic Cerebral
Palsy. There is no research in Indonesia that assesses the ankle function in patients
with Spastic CP Diplegic has done SEMLS. The purpose of this study was to
determine the influence of age, gender and time period after surgery with functional
ankle patients with CP Spastic Diplegic that has been done SEMLS in the RSO. Prof.
Dr. R. Soeharso Surakarta (RSO).

Method: This study was a cross sectional study in 43 patients (25 male and 18 female)
patients with Spastic Cerebral Palsy Diplegia that has been done SEMLS in pediatric
orthopedics clinic RSO. Prof.dr.R.Soeharso Surakarta at least 3 months
postoperatively, since January 1st 2013 to December 31st 2014. We assess ankle
function using the Oxford Ankle Foot Quissionairre for Children. From the results of
the questionnaire we value outcomes as a percentage and we regrouped into 4 groups:
value of 91% - 100% for excellent value, 81% - 90% for good, 71% - 80% for fair and
if less than 70% for poor. Then we did impact assessment for age, sex and time of the
postoperative with functional ankle score of patients with examination of linear
regression model analysis.

Results: There were 52 patients with Spastic CP Diplegi have done SEMLS but only
43 patients who qualified the inclusion criteria, the youngest patient was 5 years old
and the oldest 15 years old with a mean age of 8.3 years. From the 43 patients, 25 are
men and 18 were women. Postoperative time with the fastest time of observation was 5
months and the longest was 26 months with a mean of 14.3 months postoperatively
SEMLS. From the 43 patients there are 11 patients (25%) function are excellent, 21
patients (49%) are good, 8 patients (19%) are fair, and 3 (7%) are poor. Age factor
significantly influence the functional ankle score (p = 0.013) and postoperative time
factors also significantly influence the functional score Ankle with (p = 0.04). While
gender has no effect on the functional ankle score (p= 0,266).

Conclusion: Paediatri Orthopaedic clinic at RSO. Prof. Dr. R. Soeharso has succed
treated patients with CP Spastic Diplegic that have performed SEMLS. Age and time
of postoperative significantly influence the functional ankle score in patients with CP
Spatik Diplegic that have been done SEMLS. While the sex of the patients had no
effect on the functional ankle score in patients with CP Spastic Diplegic that have
been done SEMLS.
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Keywords: RSO Prof. Dr. R. Soeharso, userSpastic Diplegic, SEMLS, Ankle
Functional Score

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DAFTAR ISI

Halaman
HALAMAN JUDUL ...................................................................................... i
HALAMAN PERSETUJUAN ...................................................................... ii
HALAMAN PENGESAHAN ........................................................................ iii
KATA PENGANTAR .................................................................................... iv
DAFTAR ISI................................................................................................... v
DAFTAR TABEL .......................................................................................... vii
DAFTAR LAMPIRAN .................................................................................. viii
RINGKASAN ................................................................................................. ix
SUMMARY .................................................................................................... xi
I. PENDAHULUAN ................................................................................... 1
A. Latar Belakang ..................................................................................... 1
B. Rumusan Masalah ................................................................................ 2
C. Tujuan Penelitian ................................................................................. 3
II. TINJAUAN PUSTAKA .......................................................................... 4
A. Sapi Perah FH ...................................................................................... 4
B. Pakan Sapi Perah .................................................................................. 6
C. Minyak Ikan Lemuru............................................................................ 7
D. L-Karnitin…………………………………………………………… 9
E. Konsumsi pakan…………………………………………………….. 10
F. Efisiensi Ransum……………………………………………………. 11
G. Iofc………………………………………………………………….. 12
HIPOTESIS .................................................................................................... 13
III. MATERI DAN METODE...................................................................... 14
A. Waktu dan Tempat Penelitian. ............................................................. 14
B. Materi Penelitian .................................................................................. 14
C. Desain Penelitian .................................................................................. 17
D. Metode Penelitian................................................................................. 18
E. Analisis Data ....................................................................................... 21
IV. HASIL DAN PEMBAHASAN ............................................................... 23
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A. Konsumsi Pakan ................................................................................... 23
B. Produksi Susu ....................................................................................... 25
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C. Efisiensi Ransum.................................................................................. 26
D. Income Over Feed Cost (IOFC)........................................................... 27
V. KESIMPULAN DAN SARAN ............................................................... 29
A. Kesimpulan .......................................................................................... 29
B. Saran .................................................................................................... 29
DAFTAR PUSTAKA ..................................................................................... 30
LAMPIRAN................................................................................................... . 36

DAFTAR TABEL

No. Judul Halaman

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1. Kebutuhan nutrient sapi perah PFH laktasi to user
................................................ 15
2. Kandungan nutrient bahan pakan penyusun ransum ................................... 15