Summary:
Introduction: Increasing incidence of neurogenic luxations of the hip joint in patients with cerebral
palsy leads to combined surgeries on muscles – adductors and flexors of the hip in the effort to prevent
progression of lateral migration. Material: In 1999–2002, 289 patients (a total of 589 hip joints) were
indicated for surgical treatment on muscles in the hip region at the Orthopedic Clinic of 2nd Medical
Faculty, Charles University and Faculty Hospital Motol, Prague. Methods: Surgical approaches include
isolated and combined procedures on muscles – adductors (m. adductor longus, m. gracilis) and flexors
(m. iliopsoas, m. rectus femoris) of the hip with follow-up clinical and X-ray evaluation using migration
per cent value and Wiberg center-edge (CE) angle 2 and 6 months after surgery. Results: Best clinical
and X-ray results were achieved in children 6 years and younger. In combined procedures on adductor
muscles andm. rectus femoris, a significant improvement in centration (30–90%) was achieved in 51.7 %,
in combination with m. iliopsoas tenotomy, in 55.6 %. Wiberg CE angle increased in group 1A (children
6 years and younger and 30 % migration) in combined procedures on average by 11°, after concurrent
m. iliopsoas release by 15°. In the 2nd and 3rd age group (under 12 years, 13 years and above,
respectively), clinical improvement is apparent but X-ray findings are not markedly significant,
especially in age 10 and above. Discussion: Procedures on muscles in cerebral palsy patients are the
basic procedures that can improve centration of the hip or prevent migration progression. The best
results were achieved in patients under 6 years using combined surgeries on adductors and flexors of
the hip. Active and timely operative approach can prevent procedures on bones.
Key words:
coxa valga antetorta neurogenes, lateral migration of the hip joint,adductor tenotomy, flexor
prolongation
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