Осложнения при паллиативных вмешательствах при вывихе бедра у пациентов с ДЦП

Abstract

Introduction Hip dislocation is one of the most severe orthopedic complications among the problems in patients above 10 years of age with severe forms of cerebral palsy (CP), when reconstructive intervention is impossible. The purposes of palliative surgical orthopedic treatment in patients of this category consist in elimination or reduction of the pain syndrome, as well as elimination of the hip faulty position, possibility of limb free mobilization, improving the patient’s care conditions. Proximal femoral resection arthroplasty and valgus support osteotomy of the proximal femur combined with head resection are the main methods of palliative surgical treatment. Purpose To evaluate the encountered errors and complications, as well as to compare the authors’ own observations with the literature data. Materials and Methods The authors analyzed the complications encountered in the process of palliative surgical treatment (37 surgeries) of the hip dislocation in 22 patients which represented severe forms of motor disorders for spastic CP forms. Level V by GMFCS was observed in nine (9) cases, Level IV – in 13 cases. Proximal arthroplastic resection was performed in 11 cases (Group 1), proximal valgus support osteotomy – in 26 cases. Results The authors observed five (5) complications in Group 1 after 11 interventions (45.5%). Correction of the developed complications led to the full achievement of the desired result of treatment in five of six patients from this group (83.3%): disappearance or significant reduction of the pain syndrome, ease of hygiene, a comfortable sitting position. In Group 2 where the purpose of treatment aside from the pain syndrome elimination, the increase in the range of passive hip mobilization and achieving the proper postural management consisted in creating the conditions for passive verticalization with the lower limb support, seven (7) complications occurred after 26 interventions (26.9 %). The proper result of treatment was achieved in 24 of 26 hips after surgical correction of the complications (92,3%). Conclusion In most cases, surgical intervention is required in order to eliminate the complications after the palliative intervention, that allows, in general, achieving the desired result of treatment. When the severe pain syndrome develops due to mechanical conflict between the hip and pelvic bones through heterotopic ossifications and marked periosteal stratifications, the femoral arthroplastic resection after palliative interventions allows controlling the pain syndrome, restoring the hip passive mobility, providing postural management, but not to impart weight-bearing to the limb. It’s necessary to use only the plates with angular stability and without placing the screws in the direction of the acetabulum.