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Semitendinozus ve gastroknemius tenotomileriserebral palside diz fleksiyon kontraktürününasıl etkiler?

Yıl 2015, Cilt: 49 Sayı: 1, 51 - 56, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0078

Öz

Amaç: Artmış hamstring spastisitesine bağlı diz fleksiyon kontraktürü serebral palside (SP) en sık rastlanan diz deformitesidir. Bu çalışmada amacımız spastik SP’de semitendinozus ve gastroknemius tenotomileri sonucunda popliteal açıda meydana gelen iyileşme ve cerrahi başarıyı etkileyen faktörleri değerlendirmektir.

Çalışma planı: Çalışmaya 19 kız, 25 erkek hasta dahil edildi. Yaş ortalaması 8.1 (4-14) yıldı. 50 semi¬tendinozuz ve 28 gastroknemius tenotomisi uygulandı. Çalışmaya sadece SP tanısı olan, semitendino¬zus ve/veya gastrocnemius tenotomi ihtiyacı olan hastalar dahil edildirken daha önce etkilenen tarafta hamstring veya gastrocnemius cerrahisi geçiren hastalar dahil edilmedi. Popliteal açı işlem öncesi ve sonrasında genel anestezi altında hasta sırtüstü yatarken kalça 90º fleksiyonda ve karşı ekstremite eks¬tansiyonda tutulurken ölçüldü. Hastalar ayriyeten yedi yaşından küçük veya büyük olmalarına göre de gruplara ayrıldı.

Bulgular: Cerrahi öncesi ortalama popliteal açı semitendinosus grubunda 47.7°, gastroknemius gru¬bunda 50.9° idi. Bu gruplarda tenotomi sonrası popliteal açıdaki ortalam düşüş sırası ile 14.5° ve 6.0° oldu. Semitendinosus grubundaki yedi yaşından küçük çocuklarda popliteal açıdaki düzelme yaklaşık %34, yedi yaş ve üzerindekilerde ise %28 olarak hesaplandı.

Çıkarımlar: Sonuç olarak semitendinozus ve gastroknemius tenotomileri spastik SP’de popliteal açıda sırasıyla %30.8’lik ve %11.3’lük düzelme sağlamaktadır. Bu bulguların ortopedik cerrahlara spastik SP’de diz fleksiyon kontraktürünün tedavi planlaması hususunda yardımcı olacağına inanıyoruz.

Kaynakça

  • Horstmann HM, Bleck EE. Orthopaedic Management in Cerebral Palsy. 2nd ed. London: Mac Keith Press; 2007. p. 303-43.
  • DeLuca PA, Ounpuu S, Davis RB, Walsh JH. Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy. J Pediatr Orthop 1998;18:712-8.
  • Gage JR. Gait analysis. An essential tool in the treatment of cerebral palsy. Clin Orthop Relat Res 1993;288:126-34.
  • Kay RM, Rethlefsen SA, Skaggs D, Leet A. Outcome of medial versus combined medial and lateral hamstring lengthening surgery in cerebral palsy. J Pediatr Orthop 2002;22:169-72.
  • Csongradi J, Bleck E, Ford WF. Gait electromyography in normal and spastic children, with special reference to quadriceps femoris and hamstring muscles. Dev Med Child Neurol 1979;21:738-48.
  • Sullivan RC, Gehringer KM, Harris GF. A computer- assisted survey of results of medial hamstring surgery in children with cerebral palsy. Orthop Trans 1984;8:109.
  • Damron T, Breed AL, Roecker E. Hamstring tenotomies in cerebral palsy: long-term retrospective analysis. J Pedi- atr Orthop 1991;11:514-9.
  • Campos da Paz A Jr, Nomura AN, Braga LW, Burnett SM. Speculations on cerebral palsy. In proceedings of the British Orthopaedic Association. J Bone Joint Surg Br 1984;66:283.
  • Atar D, Zilberberg L, Votemberg M, Norsy M, Galil A. Effect of distal hamstring release on cerebral palsy pa- tients. Bull Hosp Jt Dis 1993;53:34-6.
  • Daniel DM, Stone M. Instrumented Measurement of Knee Motion. In: Daniel DM, Akeson WH, O’Connor JJ, editors. Knee Ligaments: Structure, Function, Injury and Repair. New York:Raven Press; 1990. p. 421-6.
  • Li L, Landin D, Grodesky J, Myers J. The function of gastrocnemius as a knee flexor at selected knee and ankle angles. J Electromyogr Kinesiol 2002;12:385-90.
  • Baddar A, Granata K, Damiano DL, Carmines DV, Blan- co JS, Abel MF. Ankle and knee coupling in patients with spastic diplegia: effects of gastrocnemius-soleus lengthen- ing. J Bone Joint Surg Am 2002;84:736-44.
  • Silfverskiöld N. Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic condi- tions. Acta Chir Scan 1924;56:315-30.
  • Strayer Lm Jr. Recession Of The Gastrocnemius; An Op- eration To Relieve Spastic Contracture Of The Calf Mus- cles. J Bone Joint Surg Am 1950;32:671-6.
  • Sharps CH, Clancy M, Steel HH. A long-term retrospec- tive study of proximal hamstring release for hamstring con- tracture in cerebral palsy. J Pediatr Orthop 1984;4:443-7.
  • van der Linden ML, Aitchison AM, Hazlewood ME, Hillman SJ, Robb JE. Effects of surgical lengthening of the hamstrings without a concomitant distal rectus femoris transfer in ambulant patients with cerebral palsy. J Pediatr Orthop 2003;23:308-13.
  • Ettema GJ. Gastrocnemius muscle length in relation to knee and ankle joint angles: verification of a geometric model and some applications. Anat Rec 1997;247:1-8.
  • Ray RL, Ehrlich MG. Lateral hamstring transfer and gait improvement in the cerebral palsy patient. J Bone Joint Surg Am 1979;61:719-23.
  • Sutherland DH, Schottstaedt ER, Larsen LJ, Ashley RK, Callander JN, James PM. Clinical and electromyographic study of seven spastic children with internal rotation gait. J Bone Joint Surg Am 1969;51:1070-82.
  • Gordon AB, Baird GO, McMulkin ML, Caskey PM, Fer- guson RL. Gait analysis outcomes of percutaneous medial hamstring tenotomies in children with cerebral palsy. J Pe- diatr Orthop 2008;28:324-9.
  • Evans EB. The status of surgery of the lower extremities in cerebral palsy. Clin Orthop Relat Res 1966;47:127-39.
  • Baumann JU, Ruetsch H, Schürmann K. Distal hamstring lengthening in cerebral palsy. An evaluation by gait analy- sis. Int Orthop 1980;3:305-9.
  • Dhawlikar SH, Root L, Mann RL. Distal lengthening of the hamstrings in patients who have cerebral palsy. Long-term retrospective analysis. J Bone Joint Surg Am 1992;74:1385-91.
  • Drummond DS, Rogala E, Templeton J, Cruess R. Proxi- mal hamstring release for knee flexion and crouched pos- ture in cerebral palsy. J Bone Joint Surg Am 1974;56:1598- 602.
  • Grant AD, Feldman R, Lehman WB. Equinus deformity in cerebral palsy: a retrospective analysis of treatment and function in 39 cases. J Pediatr Orthop 1985;5:678-81.
  • Phelps Wm. Long-term results of orthopaedic surgery in cerebral palsy. J Bone Joint Surg Am 1957;39:53-9.
  • Ten Berge SR, Halbertsma JP, Maathuis PG, Verheij NP, Dijkstra PU, Maathuis KG. Reliability of popliteal angle measurement: a study in cerebral palsy patients and healthy controls. J Pediatr Orthop 2007;27:648-52.
  • Katz K, Rosenthal A, Yosipovitch Z. Normal ranges of pop- liteal angle in children. J Pediatr Orthop 1992;12:229-31.

Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy

Yıl 2015, Cilt: 49 Sayı: 1, 51 - 56, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0078

Öz

Objective: The aim of this study was to determine the efficacy of semitendinosus and gastrocnemius tenotomies on popliteal angle presenting knee flexion spasticity in children with cerebral palsy (CP).

Methods: The study included 44 patients (25 males, 19 females; mean age: 8.1 years, range: 4 to 14 years) with spastic CP who underwent surgery for knee flexion spasticity. A total of 78 semitendinosus tenotomies and 28 associated gastrocnemius tenotomies were performed. Popliteal angle was measured under general anesthesia before and after surgery. Patients were divided into groups according to age (younger and older than 7 years), severity of deformity and type of CP.

Results: Mean popliteal angles decreased by 14.3º (30.1%) following semitendinosus tenotomy and by 6.1º (12%) following gastrocnemius tenotomy (p=0.0001). The change in popliteal angle was not statistically significant according to age, severity of flexion spasticity, and type of CP palsy. There was a significant difference following gastrocnemius tenotomy between groups with a popliteal angle of greater or lesser than 50º (p=0.0001).

Conclusion: Semitendinosus and gastrocnemius tenotomies improved popliteal angle by 30.1% and 12%, respectively. Age, preoperative popliteal angle or anatomical disease classification did not a significantly affect popliteal angle.

Kaynakça

  • Horstmann HM, Bleck EE. Orthopaedic Management in Cerebral Palsy. 2nd ed. London: Mac Keith Press; 2007. p. 303-43.
  • DeLuca PA, Ounpuu S, Davis RB, Walsh JH. Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy. J Pediatr Orthop 1998;18:712-8.
  • Gage JR. Gait analysis. An essential tool in the treatment of cerebral palsy. Clin Orthop Relat Res 1993;288:126-34.
  • Kay RM, Rethlefsen SA, Skaggs D, Leet A. Outcome of medial versus combined medial and lateral hamstring lengthening surgery in cerebral palsy. J Pediatr Orthop 2002;22:169-72.
  • Csongradi J, Bleck E, Ford WF. Gait electromyography in normal and spastic children, with special reference to quadriceps femoris and hamstring muscles. Dev Med Child Neurol 1979;21:738-48.
  • Sullivan RC, Gehringer KM, Harris GF. A computer- assisted survey of results of medial hamstring surgery in children with cerebral palsy. Orthop Trans 1984;8:109.
  • Damron T, Breed AL, Roecker E. Hamstring tenotomies in cerebral palsy: long-term retrospective analysis. J Pedi- atr Orthop 1991;11:514-9.
  • Campos da Paz A Jr, Nomura AN, Braga LW, Burnett SM. Speculations on cerebral palsy. In proceedings of the British Orthopaedic Association. J Bone Joint Surg Br 1984;66:283.
  • Atar D, Zilberberg L, Votemberg M, Norsy M, Galil A. Effect of distal hamstring release on cerebral palsy pa- tients. Bull Hosp Jt Dis 1993;53:34-6.
  • Daniel DM, Stone M. Instrumented Measurement of Knee Motion. In: Daniel DM, Akeson WH, O’Connor JJ, editors. Knee Ligaments: Structure, Function, Injury and Repair. New York:Raven Press; 1990. p. 421-6.
  • Li L, Landin D, Grodesky J, Myers J. The function of gastrocnemius as a knee flexor at selected knee and ankle angles. J Electromyogr Kinesiol 2002;12:385-90.
  • Baddar A, Granata K, Damiano DL, Carmines DV, Blan- co JS, Abel MF. Ankle and knee coupling in patients with spastic diplegia: effects of gastrocnemius-soleus lengthen- ing. J Bone Joint Surg Am 2002;84:736-44.
  • Silfverskiöld N. Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic condi- tions. Acta Chir Scan 1924;56:315-30.
  • Strayer Lm Jr. Recession Of The Gastrocnemius; An Op- eration To Relieve Spastic Contracture Of The Calf Mus- cles. J Bone Joint Surg Am 1950;32:671-6.
  • Sharps CH, Clancy M, Steel HH. A long-term retrospec- tive study of proximal hamstring release for hamstring con- tracture in cerebral palsy. J Pediatr Orthop 1984;4:443-7.
  • van der Linden ML, Aitchison AM, Hazlewood ME, Hillman SJ, Robb JE. Effects of surgical lengthening of the hamstrings without a concomitant distal rectus femoris transfer in ambulant patients with cerebral palsy. J Pediatr Orthop 2003;23:308-13.
  • Ettema GJ. Gastrocnemius muscle length in relation to knee and ankle joint angles: verification of a geometric model and some applications. Anat Rec 1997;247:1-8.
  • Ray RL, Ehrlich MG. Lateral hamstring transfer and gait improvement in the cerebral palsy patient. J Bone Joint Surg Am 1979;61:719-23.
  • Sutherland DH, Schottstaedt ER, Larsen LJ, Ashley RK, Callander JN, James PM. Clinical and electromyographic study of seven spastic children with internal rotation gait. J Bone Joint Surg Am 1969;51:1070-82.
  • Gordon AB, Baird GO, McMulkin ML, Caskey PM, Fer- guson RL. Gait analysis outcomes of percutaneous medial hamstring tenotomies in children with cerebral palsy. J Pe- diatr Orthop 2008;28:324-9.
  • Evans EB. The status of surgery of the lower extremities in cerebral palsy. Clin Orthop Relat Res 1966;47:127-39.
  • Baumann JU, Ruetsch H, Schürmann K. Distal hamstring lengthening in cerebral palsy. An evaluation by gait analy- sis. Int Orthop 1980;3:305-9.
  • Dhawlikar SH, Root L, Mann RL. Distal lengthening of the hamstrings in patients who have cerebral palsy. Long-term retrospective analysis. J Bone Joint Surg Am 1992;74:1385-91.
  • Drummond DS, Rogala E, Templeton J, Cruess R. Proxi- mal hamstring release for knee flexion and crouched pos- ture in cerebral palsy. J Bone Joint Surg Am 1974;56:1598- 602.
  • Grant AD, Feldman R, Lehman WB. Equinus deformity in cerebral palsy: a retrospective analysis of treatment and function in 39 cases. J Pediatr Orthop 1985;5:678-81.
  • Phelps Wm. Long-term results of orthopaedic surgery in cerebral palsy. J Bone Joint Surg Am 1957;39:53-9.
  • Ten Berge SR, Halbertsma JP, Maathuis PG, Verheij NP, Dijkstra PU, Maathuis KG. Reliability of popliteal angle measurement: a study in cerebral palsy patients and healthy controls. J Pediatr Orthop 2007;27:648-52.
  • Katz K, Rosenthal A, Yosipovitch Z. Normal ranges of pop- liteal angle in children. J Pediatr Orthop 1992;12:229-31.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orijinal Makale
Yazarlar

Ilker Sarikaya Bu kişi benim

Muharrem Inan Bu kişi benim

Ali Seker Bu kişi benim

Yayımlanma Tarihi 19 Mart 2015
Yayımlandığı Sayı Yıl 2015 Cilt: 49 Sayı: 1

Kaynak Göster

APA Sarikaya, I., Inan, M., & Seker, A. (2015). Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy. Acta Orthopaedica Et Traumatologica Turcica, 49(1), 51-56. https://doi.org/10.3944/AOTT.2015.14.0078
AMA Sarikaya I, Inan M, Seker A. Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy. Acta Orthopaedica et Traumatologica Turcica. Mart 2015;49(1):51-56. doi:10.3944/AOTT.2015.14.0078
Chicago Sarikaya, Ilker, Muharrem Inan, ve Ali Seker. “Improvement of Popliteal Angle With Semitendinosus or Gastrocnemius Tenotomies in Children With Cerebral Palsy”. Acta Orthopaedica Et Traumatologica Turcica 49, sy. 1 (Mart 2015): 51-56. https://doi.org/10.3944/AOTT.2015.14.0078.
EndNote Sarikaya I, Inan M, Seker A (01 Mart 2015) Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy. Acta Orthopaedica et Traumatologica Turcica 49 1 51–56.
IEEE I. Sarikaya, M. Inan, ve A. Seker, “Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy”, Acta Orthopaedica et Traumatologica Turcica, c. 49, sy. 1, ss. 51–56, 2015, doi: 10.3944/AOTT.2015.14.0078.
ISNAD Sarikaya, Ilker vd. “Improvement of Popliteal Angle With Semitendinosus or Gastrocnemius Tenotomies in Children With Cerebral Palsy”. Acta Orthopaedica et Traumatologica Turcica 49/1 (Mart 2015), 51-56. https://doi.org/10.3944/AOTT.2015.14.0078.
JAMA Sarikaya I, Inan M, Seker A. Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy. Acta Orthopaedica et Traumatologica Turcica. 2015;49:51–56.
MLA Sarikaya, Ilker vd. “Improvement of Popliteal Angle With Semitendinosus or Gastrocnemius Tenotomies in Children With Cerebral Palsy”. Acta Orthopaedica Et Traumatologica Turcica, c. 49, sy. 1, 2015, ss. 51-56, doi:10.3944/AOTT.2015.14.0078.
Vancouver Sarikaya I, Inan M, Seker A. Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy. Acta Orthopaedica et Traumatologica Turcica. 2015;49(1):51-6.