Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2007; 74(6):382-387 | DOI: 10.55095/achot2007/062

Acetabuloplastika u dětí s dětskou mozkovou obrnouPůvodní práce

A. SCHEJBALOVÁ, P. CHLÁDEK

Ortopedická klinika 2. LF UK a FN Motol - Dětská a dospělá ortopedie a traumatologie, Praha

PURPOSE OF THE STUDY:
Acetabuloplasty as an isolated surgical procedure is one of the options allowing for hip joint realignment in cerebral palsy patients. Also, it is often involved in combined techniques used for hip joint reconstruction.

MATERIAL:
In the years 2004-2005, 20 cerebral palsy patients, aged from 4 to 13 years, were indicated for acetabuloplasty. The group included children with varying degrees of locomotor disability, ranging from inability even to crawl to ability to move without support (stages 2 to 7 on the Vojta scale).

METHODS:
Clinical and X-ray findings were evaluated at 2 and 6 months after surgical treatment and then every 6 months of follow-up. The X-ray finding was described by means of CE angle (Wiberg) values and hip migration percentage.

RESULTS:
Of 21 hips (in 20 patients) treated by acetabuloplasty in our modification during the two years, one developed recurrent dorsal dislocation which was possible to deal with by conservative treatment. All hips pre-operatively categorized as group B or group C were post-operatively assessed as group A hips. Subsequent migration of the acetabulum occurred within a year in two patients with distinct original asymmetry.

DISCUSSION:
Surgery on bones comprising the hip joint in cerebral palsy patients is indicated according to the degree of lateral migration and changes in hip joint geometry involving the proximal femur or pelvis, or in combination with open reduction. Acetabuloplasty is indicated as an isolated procedure or as part of combined techniques leading to a better coverage of the hip joint. It is recommended for children up to 10 years of age, but also older ones, in whom the flexibility of child bones enables us to do without internal osteosynthesis.

CONCLUSIONS:
Acetabuloplasty is indicated as an isolated surgical procedure for hip joint subluxation in cerebral palsy children. It has no adverse effects on hip abductors that, in cerebral palsy patients, are 85 % insufficient. It improves hip joint symmetry and helps to avoid more demanding reconstructive or palliative procedures.

Klíčová slova: cerebral palsy, acetabuloplasty, lateral migration

Přijato: 25. únor 2007; Zveřejněno: 1. prosinec 2007  Zobrazit citaci