The spastic hip in children and adolescents

被引:15
作者
Dohin, Bruno [1 ,2 ]
机构
[1] Univ Jean Monnet, CHU Nord, Serv Chirurg Pediat, F-42055 St Etienne 02, France
[2] Univ Jean Monnet, LIBM, Campus Sante Innovat,10 Rue Marandiere, F-42270 St Priest En Jarez, France
关键词
Cerebral palsy; Hip dislocation; Spasticity; Neurological hip; Hip surgery; CHRONICALLY DISLOCATED HIP; PROXIMAL FEMORAL RESECTION; CEREBRAL-PALSY; SALVAGE PROCEDURES; PELVIC OBLIQUITY; FOLLOW-UP; DISPLACEMENT; SURGERY; SUBLUXATION; PREVENTION;
D O I
10.1016/j.otsr.2018.03.018
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
The hip is the joint most exposed to orthopaedic complications in cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial immaturity of the hip allows the forces applied by the spastic and retracted muscles to displace the femoral head, eventually causing it to dislocate. The risk of hip dislocation increases with the severity and extent of CP, exceeding 70% in the most severe cases. Hip dislocation causes pain in up to 30% of cases, carries a risk of orthopaedic and cutaneous complications and hinders patient installation and nursing care. These adverse outcomes warrant routine screening, which has been proven effective in lessening the frequency and severity of hip displacement. Preventive techniques including physical therapy, orthoses and treatments to alleviate spasticity are strongly recommended in every case. The beneficial effects of treating spasticity, if needed via neurosurgical procedures, have been convincingly established. Orthopaedic surgery is required when prevention fails. Soft-tissue release is designed to correct the asymmetry in the forces applied by the muscles. Femoral osteotomy creates the possibility for spontaneous correction of secondary acetabular dysplasia. Progress has been made in standardising the use of multilevel surgery involving the soft tissues, femur and pelvis, which is often effective in correcting the morphological abnormalities and stabilising the joint. When hip pain or alterations are severe, hip resection or total hip arthroplasty are highly effective in alleviating the pain and improving patient comfort. The spastic hip is a complex condition in which currently available screening protocols and treatment strategies have been proven effective in benefitting patient outcomes. (C) 2018 Elsevier Masson SAS. All rights reserved.
引用
收藏
页码:S133 / S141
页数:9
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