Improvement of possibilition of verticalisation in patients whit spino bifida after surgery of the hip and knee contractures and intensive rehabilitation programme
Abstract
Introduction: The main aim of the orthopedic treatment of the patients with the high level lesions in spina bifida is assuring the patients to the upright body position. When the contractures progresses and limitates patients verticalisation, surgically treatment is necessary.
Material and methods: From 01.08.1999 to 31.08.2003, 19 children with spina bifida were treated at our Department. At 12 girls and 7 boys (on the average age 6,2 years) the hip flexion – abduction and knee flexion contractures were released. The hip flexion – abduction contractures occured in 15 patients (18 hips), the knee flexion contractures in 18 (24 knees), in 1 child ( 2 knees) extension contractures were observed. Before the operation 8 children stayed in bed, 9 sited in chair, 1 was verticalisated and one of them was occasionally standing in the orthoses.
Results: During the surgical treatment in all patient’s the hip and knee contractures were released. The cast was removed at the hospital and the rehabiltation process and the teaching of verticalisation, standing and walking in apparatus were started. It was conducted in the cooperation with the Rehabilitation Department of our hospital. In the case of the lesion below L2 KAFO or AFO orthoses were used. In the high level of lesion T12 – L2 HKAFO orthoses were used. All the patients were verticalisated, even if the bone condition was poor. In the follow-up period (on the average 25,2 months), 15 patients were verticalisated (79%).
Conclusion: Release of hip and knee contractures in children with high level lesion in spina bifida and intensive rehabilitation enables to obtain the effects of the treatment that satisfy the patients and their families.
Downloads
References
Beaty J.H., Canale S.T., Roach J.W., Dias L.S., Drennan J.C., Banta J.V., Lubicky J.P., Carroll N.C., Lindseth R.E.: Current concepts review. Orthopaedic aspects of myelomeningocele. J Bone Joint Surg Am. 1990 Apr; 72-A(4), 626
Green W.B.: Treatment of hip and knee problems in myelomeningocele. Instr Course Lect. 1999; 48, 563
Mazur J.M., Shurtleff D.B., Menelaus M.B., Colliver J.: Orthopaedic management of high–level spina bifida. Early walking compared with early use of a wheelchair. J Bone Joint Surg Am. 1989 Jan; 71-A(1) 56
Broughton N.S., Menelaus M.B., Cole W.G., Shurtleff D.B.: The natural history of hip deformity in myelomeningocele. J Bone Joint Surg Br. 1993 Sep; 75-B(5) 760
Frawley P.A., Broughton N.S., Menelaus M.B.: Anterior release for fixed flexion deformity of the hip in spina bifida. J Bone Joint Surg Br. 1996 Mar; 78(2) 299
Dias L.S.: Surgical management of knee contractures in myelomeningocele. J Pediatr Orthop. 1982 Jun;2(2) 127
Snela S., Parsch K.: Follow-up study after treatment of knee flexion contractures in spina bifida patients. J Pediatr Orthop B. 2000 Jun;9(3) 154
Abraham E., Verinder D.G., Sharrard W.J.: The treatment of flexion contracture of the knee in myelomeningocele. J Bone Joint Surg Br. 1977 Nov; 59-B(4) 433
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2005 Medical Journal of the Rzeszow University
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
