Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy
Yıl: 2018 Cilt: 29 Sayı: 1 Sayfa Aralığı: 8 - 12 Metin Dili: İngilizce DOI: 10.5606/ehc.2018.59227 İndeks Tarihi: 21-11-2019
Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy
Öz: Objectives: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. Patients and methods: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range, 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1±10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre- and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. Results: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2° preoperatively and 20.4° postoperatively. In preoperative period, MP and NSA were 72.7% and 160°, respectively, which improved to 24.3% and 130°, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p<0.001). We performed revision surgery due to implant failure in two patients and detected hip subluxation due to increased pelvic obliquity in one patient who had thoracolumbar scoliosis. Conclusion: In CP patients, reconstruction of hip subluxation and dislocation with femoral VDRO and Dega transiliac osteotomy establish femoroacetabular congruency. Without any cast immobilization, early physical therapy is encouraged for immediate recovery.
Anahtar Kelime: Konular:
Serebral palsili çocuklarda kalça subluksasyonu ve dislokasyonunun cerrahi rekonstrüksiyonu
Öz: Amaç: Bu çalışmada serebral palsi (SP) hastalarında kalça subluksasyonu ve dislokasyonunun tedavisinde femur varus derotasyon osteotomisi (VDRO) ve Dega transiliyak osteotomisinin etkinliği incelendi. Hastalar ve yöntemler: Geriye dönük bu çalışmaya Temmuz 2010 - Aralık 2015 tarihleri arasında kalça subluksasyonu ve dislokasyonu nedeniyle ameliyat edilen 22 SP hastasının (9 erkek, 13 kadın; ort. yaş 8.7 yıl; dağılım 4-18 yıl) 25 kalçası dahil edildi. Ortalama takip süresi 36.1±10.4 ay (dağılım 20-65.6 ay) idi. Tüm olgularda femur VDRO ve Dega transiliyak osteotomisi uygulandı. Ameliyat sonrasında hastaların hiçbirine alçı ile immobilizasyon uygulanmadı. Hastalar ameliyat öncesinde ve takip süresinde kaba motor fonksiyon sınıflandırma sistemi ile klinik olarak değerlendirildi. Asetabular indeks (Aİ), migrasyon yüzdesi (MY) ve boyun-cisim açısı (BCA) ameliyat öncesinde, sonrasında ve takip süresinde çekilen pelvis grafileri ile ölçülüp belgelendi. Ameliyat sırası ve sonrası komplikasyonlar kaydedildi. Bulgular: Kaba motor fonksiyon sınıflandırma sistemi skorları 16 hastada iyileşti. Ameliyat öncesi ortalama AI 33.2°, ameliyat sonrası 20.4° idi. Ameliyat öncesi sırasıyla %72.7 ve 160° olan MY ve BCA, ameliyat sonrası sırasıyla %24.3 ve 130°’ye iyileşti. Aİ, BCA ve MY’deki ameliyat sonrası iyileşme istatistiksel olarak anlamlı idi (p<0.001). İki hastada implant yetmezliği nedeniyle revizyon cerrahisi uygulandı ve torakolomber skolyozu olan bir hastada artmış pelvik oblisiteye bağlı kalça subluksasyonu saptandı. Sonuç: Serebral palsi hastalarında kalça subluksasyonu ve dislokasyonunun femur VDRO ve Dega transiliyak osteotomisi ile rekonstrüksiyonu femoroasetabular uyum sağlar. Hızlı düzelme için alçı ile immobilizasyon olmaksızın erken fizyoterapi teşvik edilir.
Anahtar Kelime: Konular:
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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| APA | oto m, SARIKAYA i, Erdal O, ŞEKER A (2018). Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. , 8 - 12. 10.5606/ehc.2018.59227 |
| Chicago | oto murat,SARIKAYA ilker,Erdal Ozan Ali,ŞEKER Ali Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. (2018): 8 - 12. 10.5606/ehc.2018.59227 |
| MLA | oto murat,SARIKAYA ilker,Erdal Ozan Ali,ŞEKER Ali Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. , 2018, ss.8 - 12. 10.5606/ehc.2018.59227 |
| AMA | oto m,SARIKAYA i,Erdal O,ŞEKER A Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. . 2018; 8 - 12. 10.5606/ehc.2018.59227 |
| Vancouver | oto m,SARIKAYA i,Erdal O,ŞEKER A Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. . 2018; 8 - 12. 10.5606/ehc.2018.59227 |
| IEEE | oto m,SARIKAYA i,Erdal O,ŞEKER A "Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy." , ss.8 - 12, 2018. 10.5606/ehc.2018.59227 |
| ISNAD | oto, murat vd. "Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy". (2018), 8-12. https://doi.org/10.5606/ehc.2018.59227 |
| APA | oto m, SARIKAYA i, Erdal O, ŞEKER A (2018). Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 29(1), 8 - 12. 10.5606/ehc.2018.59227 |
| Chicago | oto murat,SARIKAYA ilker,Erdal Ozan Ali,ŞEKER Ali Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 29, no.1 (2018): 8 - 12. 10.5606/ehc.2018.59227 |
| MLA | oto murat,SARIKAYA ilker,Erdal Ozan Ali,ŞEKER Ali Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), vol.29, no.1, 2018, ss.8 - 12. 10.5606/ehc.2018.59227 |
| AMA | oto m,SARIKAYA i,Erdal O,ŞEKER A Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2018; 29(1): 8 - 12. 10.5606/ehc.2018.59227 |
| Vancouver | oto m,SARIKAYA i,Erdal O,ŞEKER A Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2018; 29(1): 8 - 12. 10.5606/ehc.2018.59227 |
| IEEE | oto m,SARIKAYA i,Erdal O,ŞEKER A "Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy." Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 29, ss.8 - 12, 2018. 10.5606/ehc.2018.59227 |
| ISNAD | oto, murat vd. "Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy". Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 29/1 (2018), 8-12. https://doi.org/10.5606/ehc.2018.59227 |
