Serebral palsili hastalarda suprakondiler femur ekstansiyon osteotomisi ve patellar tendon ilerletme sonuçları

Öz

GİRİŞ ve AMAÇ: Diz fleksiyon kontraktürü ve patella alta serebral palsi (SP) hastalarında yaygın görülen ve yürüme fonksiyonunu önemli ölçüde bozan patolojilerdir. Suprakondiler femur ekstansiyon osteotomisi (SFEO) ve patellar tendon ilerletme (PTİ) ameliyatları SP kaynaklı diz fleksiyon kontraktürünün ve patella altanın tedavisinde uygulanan yöntemler arasındadır. Bu çalışmanın amacı SP kaynaklı diz fleksiyon kontraktürünün ve patella altanın tedavisinde uygulanan SFEO ve PTİ ameliyatlarının etkinliğinin incelenmesidir.
YÖNTEM ve GEREÇLER: Bu retrospektif çalışmaya 2013 ve 2015 yılları arasında SP tanısı olan ve diz fleksiyon kontraktürü için SFEO ve patella alta için PTİ ameliyatı yapılan on bir hasta (22 diz) dâhil edildi. Ameliyat edildiklerinde hastaların ortalama yaşı 13; ortalama takip süresi 31 aydı. Hastalar klinik olarak kaba motor fonksiyon sınıflama sistemi (KMFSS) ve diz fleksiyon kontraktürünün nüksü ile radyografik olarak ameliyat öncesi, ameliyat sonrası, takip anterior-posterior ve lateral diz grafileri ile değerlendirildi. Koshino-Sugimoto indeksi (KS), komplikasyonlar kaydedildi.
BULGULAR: KMFSS değerleri yedi hastada yükselmiştir. Takipler sırasında bir olguda diz fleksiyon deformitesinin nüksü saptandı ve SFEO ile tedavi edildi. Ameliyat öncesi KS indeksi ortalaması 1,37 iken ameliyat sonrasında 1,07 ve son takipte 1,24 ölçüldü (p=0.004). İki olguda takiplerde serklaj teli iritasyonu saptandı ve ilave cerrahi ile teller çıkarıldı.
TARTIŞMA ve SONUÇ: SP’ye bağlı diz fleksiyon kontraktürünün ve patella altanın SFEO ve PTİ ile başarılı radyolojik ve klinik sonuçlara ulaşılarak tedavi edildiği görülmüştür.

Anahtar Kelimeler

• serebral palsi
• diz fleksiyon kontraktürü
• patella alta
• suprakondiler femur ekstansiyon osteotomisi
• patellar ilerletme

Results of supracondylar femoral extension osteotomy and patellar tendon advancement in patients with cerebral palsy

Öz

INTRODUCTION: Knee flexion contracture and patella alta patella alta are common problems in cerebral palsy (CP) patients and disrupts gait function significantly. Supracondylar femur extension osteotomy (SFEO) and patellar tendon advancement (PTA) are among the leading treatment methods. We reviewed the efficacy of SFEO and PTA in the treatment of knee flexion contracture and patella alta of CP patients.
METHODS: In this retrospective study 22 hips of 11 CP patients who were operated between 2013 and 2015 were reviewed. The mean age was 13 years when the patients were operated and the mean follow-up period was 31 months. SFEO and PTA were peroformed in all cases. Patients were evaluated clinically with gross motor function classification system (GMFCS) and recurrence of knee flexion contracture and radiologically with knee radiograph. The Koshino-Sugimoto index (KS) was recorded.
RESULTS: GMFCS scores were improved in seven patients. Recurrence of knee flexion contracture was detected in one case who was treated with revision SFEO. The mean preoperatively KS was 1,37; postoperatively KS was 1,07 and follow-up 1,24 (p=0.004). Cerclage wire irritation was detected in two cases and extracted with additionally surgical procedures.
DISCUSSION AND CONCLUSION: Reconstruction of knee flexion contracture and patella alta in CP patients with SFEO and PTA provides successful clinical and radiological results.

Anahtar Kelimeler

• cerebral palsy
• knee flexion contracture
• patella alta
• supracondylar femoral extension osteotomy
• patellar advancement

Kaynakça

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