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Adductor myotomy in cerebral palsy: uni or bilateral
Federico Fernandez-Palazzi1, Annie Carpio
1Paediatric Orthopaedics and Neuro-Orthopaedic Unit, Caracas Medical Center, Juan de Villegas St. San Bernardino, Caracas, 1011, Venezuela, feferpal@telcel.net.ve.
Introduction:
In patients with cerebral palsy, the prevention of hip dislocation should be the "primum momens" of early surgery. The surgery consists of a myotomy of the adductor medium, mayor and gracilis, and, in non-ambulatory cases, a neurectomy of the second branch of the obturator nerve. The purpose of this study was to examine whether the adductor myotomy should be performed on the contralateral side at one sitting.
Materials And Methods:
In a study performed by our team on 1,474 patients, 792 patients (53.7%) had a unilateral procedure and 682 a bilateral procedure.
Results:
The non-myotomized spastic adductors alter the movement of forces on the femoral head and, thus, 78.20% required a secondary contralateral procedure. The dislocation of the hip in patients whose operations were performed at two different sittings occurred in 20% of cases, and in those with a bilateral procedure at one sitting only in 1%. The increase in the cervicodiaphyseal angle occurred in 23.1% of patients with surgeries performed at two sittings and only in 10% of patients with bilateral procedures at one sitting.
Conclusions:
Our results suggest that the bilateral surgical procedure at one sitting should be recommended to equalize the movements of force in spastic hips.
