Soft-tissue release for hip subluxation and dislocation in cerebral palsy

Takeuchi, Ryoko; Mutsuzaki, Hirotaka; Shimizu, Yoshiki; Mataki, Yuki; Kamada, Hiroshi

doi:10.2185/jrm.2939

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…En la actualidad, la cirugía preventiva se mantiene como una opción para retrasar la necesidad de reconstrucción ósea hasta una edad y etapa del desarrollo más apropiada para el desarrollo del niño. 4,5 De acuerdo con lo reportado por Miller y colaboradores, las caderas con un PMR entre 30-60% deben monitorearse y continuar con su seguimiento hasta la adultez. Las caderas con un PMR entre 60-90% deben tratarse de manera quirúrgica.…”

Section: Discussionunclassified

Evaluación radiográfica del desplazamiento de cadera en niños con parálisis cerebral tratados profilácticamente con cirugía de tejidos blandos

Osuna-Cámara¹,

Martínez-Rodríguez²

2020

Revista Mexicana De Ortopedia Pediátrica

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Section: Discussionunclassified

Evaluación radiográfica del desplazamiento de cadera en niños con parálisis cerebral tratados profilácticamente con cirugía de tejidos blandos

Osuna-Cámara¹,

Martínez-Rodríguez²

2020

Revista Mexicana De Ortopedia Pediátrica

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“…It seems that the hip has more complex mechanical characteristics than seen. There are too many anatomic and biomechanical factors, such as ligaments, the joint capsule, dynamics of the knee, and gait deformities, with the potential to affect the muscle stiffness around the hip …”

Section: Discussionmentioning

confidence: 99%

Association Between the Elasticity of Hip Muscles and the Hip Migration Index in Cerebral Palsy

Analan

Aslan

2019

J of Ultrasound Medicine

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Objectives-Cerebral palsy (CP) increases the risk of hip displacement during childhood. Abnormal hip muscle forces have been proposed as the predisposing factors. In CP, the amount of hip displacement is commonly evaluated by the Reimers hip migration index (MI) on an anteroposterior pelvic radiograph. To the best of our knowledge, the association between the elasticity of hip muscles measured by shear wave elastography and the MI has not been studied yet. Herein, we aimed to analyze the correlation between the elasticity of hip muscles and the MI.Methods-Bilateral hips of 25 children with spastic CP were included prospectively in this study. Anteroposterior pelvic radiographs were used to measure the MI. Shear wave elastography was performed to evaluate the elasticity of muscles. The correlation between the MI and the elasticity of hip flexor and adductor muscle groups was assessed. Also, the association between the elasticity of agonist/antagonist muscles was analyzed.Results-The MI showed fair to good correlations with hip flexors and adductors for both readers (0.71 ≥ r ≥ 0.52). The mean MIs of the patients AE SDs were 22.64% AE 7.79% for reader 1 and 21.55% AE 8.83% for reader 2. The elasticity of agonist/antagonist muscle groups showed little/no to a weak correlation for both readers (0.32 ≥ r ≥ -0.07).Conclusions-Although, hip flexor and adductor muscle elasticity showed a correlation with MI, it seems very hard to say that increased elasticity of hip flexor and adductor muscles causes hip dislocation.

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“…V důsledku nerovnováhy svalů vzniká instabilita i u MMC (myelomeningokéla) (7) nebo u jiných neuromuskulárních chorob. Při včasné detekci je nejefektivnější měkkotkáňové uvolnění kontraktur kyčelního kloubu (19,20,22). Většinou se ovšem setkáváme s pokročilými případy, kdy je hlavice dislokována z jamky kyčelního kloubu a došlo k deformitě okraje kloubní jamky a stav si vyžaduje kromě měkkotkáňového uvolnění i kostní zákrok (3,13,14).…”

Section: úVodunclassified

Simultaneous Bilateral Femoral Osteotomies in Neurogenic Hip Instability: a Feasibility Study

Poul¹,

Mala²,

Urbášek³

et al. 2021

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYThe study aimed to evaluate the intraoperative and early postoperative response to simultaneous bilateral femoral osteotomy usually accompanied by soft tissue release of hip joints, or open reduction, capsuloplasty, pelvic osteotomy or extraarticular shelf procedure. MATERIAL AND METHODSA bilateral surgery was performed in 16 children. Twelve children suffered from (spastic) cerebral palsy and there was one case of paralytic dislocation in a patient with myelomeningocele, while the remaining patients suffered from chromosome I aberrations, Dandy-Walker syndrome and merosin-deficient muscular dystrophy. GMFCS Level IV and V prevailed. The patients with femoral head deformity or severe adduction contracture were removed from the study group. In all cases the LCP Pediatric Hip Plate 3.5 or 5.0 (Synthes) was used for osteosynthesis. The postoperative fixation by a hip spica cast was applied for 6 weeks, after which in most cases SWASH orthosis was used at night. The age of the patient, the hip joint finding, the GMFCS level and the type of procedure were recorded. RESULTSThe evaluation took into account the use of general anaesthesia only or a combination of general and epidural anaesthesia, most often through caudal block, duration of surgery, time when blood transfusion was necessary and the volumes of blood needed, duration of stay in the Anaesthesiology and Resuscitation Unit, or Intensive Care Unit. As a response to surgery, the changes in haemoglobin levels in g/l and VAS pain score were studied. In four patients only the operative time exceeded 3 hours. Blood transfusion was necessary in 13 patients, with one blood unit being always sufficient. Two patients were admitted to the Anaesthesiology and Resuscitation Unit, the remaining patients spent 1-3 days after surgery in the ICU. The average length of hospital stay did not exceed a week. The postoperative decrease in haemoglobin levels quickly improved. The pain intensity was regularly recorded postoperatively and on day 3-4 it was evaluated as moderate, with patients responding well to common analgesics (VAS 4-7). DISCUSSIONThe evaluation of duration of simultaneous bilateral procedure, postoperative recovery based on the need for blood transfusion, changes in blood count and VAS scores indicated that the procedure performed on both hip joints simultaneously does not significantly exceed the reasonable limits in terms of the patient s burden. In literature, we found only a single article on a topic of this sort, the conclusions of which are very similar. CONCLUSIONSThe simultaneous bilateral femoral osteotomy can be considered a fairly safe procedure.

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Soft-tissue release for hip subluxation and dislocation in cerebral palsy

Cited by 4 publications

References 17 publications

Evaluación radiográfica del desplazamiento de cadera en niños con parálisis cerebral tratados profilácticamente con cirugía de tejidos blandos

Evaluación radiográfica del desplazamiento de cadera en niños con parálisis cerebral tratados profilácticamente con cirugía de tejidos blandos

Association Between the Elasticity of Hip Muscles and the Hip Migration Index in Cerebral Palsy

Simultaneous Bilateral Femoral Osteotomies in Neurogenic Hip Instability: a Feasibility Study

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