[Surgical treatment of the spastic hip luxation at patients with severe form of CP]
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1Kliniczny Oddział Ortopedii i Traumatologii Dzieciecej z Pododdziałem Wczesnej Rehabilitacji Narzadu Ruchu u Dzieci, Szpital Wojewódzki nr 2 w Rzeszowie. ewaraf@wp.pl
Insights
Schanz osteotomy improved hip abduction, reduced pain, and enhanced rehabilitation for cerebral palsy patients. This method proved more effective for treating neurogenic hip dislocations in severe CP cases.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy management
Context:
- Neurogenic hip dislocation is a common complication in severe cerebral palsy (CP).
- Operative management aims to improve hip function, reduce pain, and enhance patient care.
- Traditional treatments like femoral head resection have variable outcomes.
Purpose:
- To assess the final results of operative treatment for luxated neurogenic hips in severe CP patients.
- To compare the effectiveness of femoral head resection (Castle procedure) versus Schanz osteotomy.
- To evaluate pain levels, nursing care, and rehabilitation possibilities post-surgery.
Summary:
- Schanz osteotomy in 9 patients (13 hips) showed significant improvements: 6 experienced no pain, 2 reported decreased pain, and nursing care improved for all.
- Femoral head resection in 5 patients (7 hips) yielded less favorable results, with only 2 pain-free patients and 3 satisfied parents.
- Schanz osteotomy led to improved hip abduction, pain reduction, and better rehabilitation, with 8 parents satisfied post-surgery. Late complications included ossification and plate destabilization in isolated cases.
Impact:
- Schanz osteotomy is a more effective surgical option for treating neurogenic hip dislocations in severe CP.
- Improved hip function and reduced pain can significantly enhance the quality of life for CP patients.
- The findings support evidence-based surgical decision-making in pediatric orthopedic management of CP complications.
Background:
The aim of our study was the assessment the final results of the operative treatment of the luxated neurogenic hips at patients with severe form of CP.
Materials And Methods:
Analysis was performed on 13 CP patients with hemiplegia bilateralis treated in our department because of the neurogenic hip dislocation. At 5 patients (7 hips) was performed resection of femoral head according to Castle. At 9 patients (13 hips) the femoral osteotomy according to Schanz were done. The follow up ranged from 1 to 3 years. The early and late complications such as pain before and after surgery and nursing possibilities were analysed. The 4 questions concerned on the status before and after surgery. They assessed the pain, possibilities of crotch nursing and rehabilitation as well as total opinion about the final result of surgery.
Results:
At the group of patients after the resection of the femoral head two of them had no pain, one patients complained on the decreasing pain, and two hadn't any changes. Only three parents assessed the surgery as satisfactory. At the group after osteotomy according to Schanz six patients observed no pain, two complained on the decreasing pain and one didn't observe any changes. The possibilities of nursing improved at all patients in this group. Eight parents were satisfied and one dissatisfied after surgery. As late complications we have classified the following: ossification around the hip joint in one case and destabilization of the plate in one another.
Conclusions:
The Schanz osteotomy permitted us to achieve the improvement in abduction of the hips at majority of the patients, the reduction of the pain and improvement in rehabilitation's possibilities. In our experience this method was more effective in the treatment of the luxated hips at patients with severe form of CP.
