Zusammenfassung
Bei der multidisziplinären Behandlung des zerebralparetischen Patienten nimmt die operative Behandlung der oberen Extremität einen festen Platz im gesamten Behandlungskonzept ein. Sie bleibt aber selektiv und ist deshalb zahlenmäßig im Vergleich zur unteren Extremität niedrig. In den meisten Fällen führen reine Multi-level-Weichteileingriffe, die auf die individuellen funktionellen Bewegungsstörungen abgestimmt sind, zu einem befriedigenden Behandlungsresultat. Knöcherne Korrekturoperationen in Form von Arthrodesen oder Osteotomien sind hingegen selten erforderlich. Die retrospektive Analyse von 209 Patienten mit infantiler Zerebralparese, die von 1975–2000 operativ an der oberen Extremität behandelt wurden, zeigte eine Patientenzufriedenheit mit dem funktionellen Behandlungsergebnis von 68,4%. Mit dem kosmetischen Resultat waren 97,6% aller Patienten zufrieden. Die operative Behandlung zerebralparetischer Deformitäten der oberen Extremität erfordert eine langjährige Erfahrung, um eine differenzierte Indikation stellen und die geeigneten Op.-Techniken auswählen zu können.
Abstract
In cerebral palsy patients, surgical treatment procedures of the upper extremity have an important place in the concept of multidisciplinary care. Nevertheless, operative indications remain selective and the number of operative interventions is limited in comparison to the lower extremity. For an appropriate surgical outcome, soft tissue techniques, applied in a multilevel strategy with clear consideration of functional aspects, are often sufficient. Osseous operative corrections, i.e. osteotomies or joint fusions are restricted to selected cases. The retrospective evaluation of 209 patients who underwent surgical treatment of the upper extremity between 1975 and 2000 revealed a general satisfaction with the functional outcome in 68.4% of cases and cosmetic improvement in 97.6% of cases. The surgical treatment of upper limb deformities in cerebral palsy requires a particular focus on the correct indication and selection of an adequate surgical technique requiring outstanding experience.
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Manolikakis, G., Schörle, C.M. Die obere Extremität bei der infantilen Zerebralparese. Orthopäde 33, 1163–1172 (2004). https://doi.org/10.1007/s00132-004-0684-6
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DOI: https://doi.org/10.1007/s00132-004-0684-6