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[The hip in infantile cerebral palsy, natural developmental course and treatment concepts]
B Frischhut1, M Krismer, W Sterzinger
1Universitätsklinik für Orthopädie, Innsbruck.
Insights
Muscle release surgery in cerebral palsy (CP) patients showed varied outcomes. While beneficial for preventing hip dislocation in total body involvement cases, it led to functional deterioration in some diplegia patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) classification aids in predicting prognosis and hip problem likelihood.
- Muscle release operations were performed on 55 CP patients between 1971 and 1988.
Purpose of the Study:
- To evaluate the functional and radiological outcomes of muscle release operations in CP patients.
- To assess the impact of surgery based on neurological classification: hemiplegia, diplegia, and total body involvement.
Main Methods:
- Preoperative assessment included neuropediatric diagnosis, Rancho-los-Amigos function evaluation, and Reimers hip X-ray assessment.
- Postoperative evaluation grouped patients by neurological diagnosis.
- Surgical indications included suspected hip dislocation, and for hygiene/care/pain relief in total body involvement.
Main Results:
- Hemiplegia patients showed no significant functional or radiological changes post-surgery.
- Diplegia patients experienced functional deterioration in 21% of cases, with 16% losing ambulation ability; hip migration percentage improved from 48% to 39%.
- In total body involvement, surgery prevented hip dislocation in 90% of cases, improving migration percentage from 73% to 33%; adductor and iliopsoas release improved hygiene and pain relief.
Conclusions:
- Muscle release surgery outcomes in CP vary significantly based on the neurological classification.
- Surgery is effective in preventing hip dislocation and improving hip parameters in total body involvement CP.
- Careful patient selection and classification are crucial for optimizing surgical outcomes in cerebral palsy.
Abstract:
Classification of cerebral palsy according to the topographical distribution of clinical phenomena permits determination of a prognosis of the natural history of CP and the probability of hip problems to some extent. In 55 patients with CP, 101 muscle release operations were performed between 1971 and 1988. Preoperatively, the diagnosis was established by the neuropediatrician, function was evaluated according to the Rancho-los-amigos system, and the X-rays of the hip were assessed according to Reimers. For the postoperative evaluation patients were grouped according to neurologic diagnosis: hemiplegia (4), diplegia (19), total body involvement (31). Patients with hemiplegia had no functional or radiological changes as a result of the operation. In diplegia functional deterioration was seen in 4 cases (21%); in 3 cases (16%) this meant loss of the ability to walk. The migration percentage was improved from 48% to 39% on average. In 19 cerebral palsy patients with total body involvement surgery was considered to be indicated on the basis of a suspected dislocation of the hip. No functional changes occurred as a result of surgery. Hip dislocation was successfully prevented in 90% of the cases. The migration percentage was improved from 73% to 33%. In another 12 patients with total body involvement, adductor and iliopsoas release was performed to allow better hygiene and care and for pain relief. These goals were achieved; neither the Rancho-Los-Amigos function classification system nor X-rays were used to evaluate the results.