Prophylaxe und Therapie der Hüftgelenksluxation bei infantiler Zerebralparese (ICP): statomotorische, radiologische und klinische Ergebnisse nach subkutaner Adduktorentenotomie

Abstract

The current study assessed the clinical and radiological outcome and motor function improvement after subcutaneous adductor tenotomy in children with cerebral palsy (ICP). It was also analysed if groups with different preoperative hip functions and radiological hip migrations differed in their final clinical, radiological and motor function outcome. A prospective study of 91 children with infantile cerebral palsy (ICP, mean age 4.9 years, range: 1.1 - 15.8) with 141 hip dislocations or subluxations analysed preoperatively the hip abduction and radiologically the migration percentage (MP). Depending on the preoperative status, all patients were grouped into 3 abduction and 3 MP groups. Additionally, the motor function was classified according to the Rancho los Amigos scale. A subcutaneous adductor tenotomy was performed mono- or bilaterally and all patients were treated for 4 - 6 weeks with a hip abduction splint. Patients were assessed annually for 4 years; clinical and radiological results and the motor function were analysed according to their preoperative status. The mean hip abduction was preoperatively 30.3 +/- 1.2 degrees and was significantly improved to 50.3 +/- 1.3 degrees 1 year and to 43.3 +/- 2.2 degrees 4 years post surgery. The preoperative mean MP was preoperatively 42.3 +/- 1.3 % and was significantly improved to 34.6 % 1 year and to 31.9 % 4 years post surgery. After 4 years, 41 % had undergone a motor function improvement and 52 % no change in motor function. After 4 years, patients with a hip abduction <or= 20 degrees showed the most improvement; other abduction groups also improved significantly but to a lesser extent. The 4-year MP was significantly and to a relatively large extent improved in the groups with a preoperative MP between 25 % and 50 % and above 50 %. With a preoperative MP <or= 25 %, there was a significant but only slight improvement. The motor function was improved when the preoperative hip abduction was most restricted and the preoperative MP was high. CONCLUSION The subcutaneous adductor tenotomy in hip dislocation and subluxation of children with cerebral palsy is a safe procedure that can treat and prevent hip dislocation/subluxation in 76 % of the cases. In appropriately selected patients, the number of individuals that are "freely walking" and "walking with aid" can be doubled. MP and hip abduction are both predictors of therapy outcome.