[Spastic hip surgery in children].

BACKGROUND

Spasticity in patients with infantile cerebral palsy may lead to progressive subluxation and/or hip dislocation.

MATERIAL AND

METHODS

Retrospective, cross-sectional trial of a cohort of patients with infantile cerebral palsy who underwent subtrochanteric osteotomy of the hip at the Shriner's Hospital for children in Mexico City, with a 5-year follow-up. X-ray evaluation was conducted pre- and postoperatively and at the 5-year follow-up using the Settecerri classification.

RESULTS

Twenty cases were analyzed; mean age was 8.8 years. They included spastic quadriplegia, spastic diplegia, spastic paraplegia. Good results accounted for 50%, fair 30% and poor 20%. Good results in patients with quadriplegia represented 50%, with diplegia 25%, and with paraplegia 75%. Among patients undergoing single osteotomy, good results were 28%, fair 57%,and poor 14%; among those undergoing osteotomy plus cotyloplasty, good results were 63%, fair 9%, and poor 27%. Results with osteotomy plus soft tissues were good and fair in 50% of patients.

DISCUSSION: Spasticity and its effects are always present, regardless of surgery, treatment or no treatment; this is the reason for the recurrence of deformities or articular problems of the hip. The benefit of treatment cannot be denied despite spasticity.

CONCLUSIONS

The best results were seen among the youngest patients with spastic diplegia and spastic paraplegia. Osteotomy as a single procedure is insufficient and therefore cotyloplasty is recommended.