Summary:
Introduction. Procedure on bones in the area of hip joints in patients with cerebral palsy is indicated
according to the degree of lateral migration in the area of proximal femur and pelvis, sometimes in
combination with open surgical reposition. Material. In the years 1999–2002, the following bone
surgeries in the hip joint area were performed at the Orthopedic Clinic, 2nd Medical Faculty, Charles
University: improvement of centration, 53 hip joints in 32 patients; a palliative procedure, 22 hip joints
in 14 patients with cerebral palsy. Methods. The operative approaches include isolated and combined
procedures on bones ranging from correction of anteversion or combination with a procedure on pelvis,
possibly with an open surgical reposition, to palliative procedures. Subsequent post-surgery evaluation
was clinicaland X-ray-based,according to the migration percentage andWibergCEangle 2 and6months
after surgery. Results: In marginal and high luxation, the best results were achieved in reconstruction
of the hip joint under age of 9 years. In 2 patients (2 joints), re-luxation occurred between 6–12 months
after surgery, which represents 12.2 % from a total of 16 complete procedures. In de-rotation subtrochanteric
osteotomies, clinical findings always improved and Wiberg CE angle increased on average
by 10 %. In palliative Schanz osteotomy, postoperative improvement of the range of motion occurred in
all patients. Occasional pain was subsequently reported by 2 patients (2 hip joints). Out of the total of
22 palliative procedures, this represents 9.1 %. Discussion. Procedures on bones in the hip joint area in
patients with cerebral palsy are procedures following those on muscles, or they may be combined
simultaneously. Complete reconstruction surgeries have to be indicated in the first decade of life, when
the shape of the femoral head is not changed and the joint socket does not disappear. In patients over
the age of 10 with high luxation, it is sometimes necessary to indicate palliative procedures because of
pain and to enable improved care.
Key words:
cerebral palsy, reposition of the hip joint, femur osteotomy, acetabular reconstruction,
palliative osteotomy
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