tailieunhanh - Quản lý các rối loạn bệnh nhân bị bại não

Rối loạn Hip phổ biến ở những bệnh nhân bị bại não và bao gồm một phổ rộng, lâm sàng, từ hip nguy cơ subluxation, trật khớp, và trật khớp thoái hóa và đau. Mặc dù hông là bình thường khi sinh, một sự kết hợp của sự mất cân bằng cơ và biến dạng xương dẫn đến chứng loạn sản tiến bộ. | Management of Hip Disorders in Patients With Cerebral Palsy John M. Flynn MD and Freeman Miller MD Abstract Hip disorders are common in patients with cerebral palsy and cover a wide clinical spectrum from the hip at risk to subluxation dislocation and dislocation with degeneration and pain. Although the hip is normal at birth a combination of muscle imbalance and bony deformity leads to progressive dysplasia. The spasticity or contracture usually involves the adductor and iliopsoas muscles thus the majority of hips subluxate in a posterosuperior direction. Many patients with untreated dislocations develop pain by early adulthood. Because physical examination alone is unreliable an anteroposterior radiograph of the pelvis is required for diagnosis. Soft-tissue lengthening is recommended for children as soon as discernable hip subluxation hip abduction 30 migration index 25 is recognized. One-stage comprehensive hip reconstruction is effective treatment for children 4 years of age or older who have a migration index 60 but who have not yet developed advanced degenerative changes of the femoral head. Salvage options for the skeletally mature patient with a neglected hip are limited. J Am Acad Orthop Surg 2002 10 198-209 Hip disorders are common in children with cerebral palsy and cover a wide spectrum from the hip at risk to subluxation dislocation and dislocation with severe degeneration and pain. Three principles guide the management of these disorders. First the pathophysiology of spastic hip dysplasia differs from that of developmental dysplasia of the hip Table 1 . In children with cerebral palsy the hips are usually normal at birth with growth however a combination of muscle imbalance and bony deformity leads to progressive dysplasia. Second the natural history of hip dysplasia is marked by increasing dysfunction. With progression of hip subluxation or dislocation there is an increasingly adverse effect on hygiene sitting and gait as well as pain by early .