Beyin felcinde rotasyonel deformitenin değerlendirilmesi ve tedavisi

Rotasyonel deformiteler beyin felçli çocuklarda yaygın olarak görülen, içe dönük ve dışa dönük yürümeyi içeren alt ekstremite anormallikleridir. İçe dönük yürüme üç tür deformitenin birinden kaynaklanır: artmış femoral anteversiyon, internal tibial torsiyon ve metatarsus varus; daha nadir görülen dışa dönük yürüme ise femoral retroversiyon ve eksternal tibial torsiyondan kaynaklanır. Dikkatli fizik ve radyografik inceleme ile doğru tanı konmalıdır.

Anahtar Kelimeler:

Beyin felci, Torsiyon anomalisi, Tibia, Yürüyüş şekli, Ayak, Çocuk

The evaluation and management of rotational deformity in cerebral palsy

Rotational deformities are common lower extremity abnormalities in children with cerebral palsy, which include intoeing and outtoeing. Intoeing is caused by one of the three types of deformity: increased femoral anteversion, internal tibial torsion, and metatarsus varus, while outtoeing, the less common form, is caused by femoral retroversion and external tibial torsion. An accurate diagnosis should be made with careful physical and radiographic examination.

Keywords:

Cerebral Palsy, Torsion Abnormality, Tibia, Gait, Foot, Child,

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1. Steinwender G, Saraph V, Zwick EB, Uitz C, Linhart W. Assessment of hip rotation after gait improvement surgery in cerebral palsy. Acta Orthop Belg 2000;66:259-64.
2. Chapman ME, Duwelius PJ, Bray TJ, Gordon JE. Closed intramedullary femoral osteotomy. Shortening and derotation procedures. Clin Orthop Relat Res 1993;(287):245-51.
3. Mollica Q, Leonardi W, Travaglianti G. Correction of lower limb deformity using external fixation. Ital J Orthop Traumatol 1992;18:297-302.
4. Miller F. Gait. In: Cerebral palsy. New York: Springer; 2005. p. 251-386.
5. Mahboubi S, Horstmann H. Femoral torsion: CT measurement. Radiology 1986;160:843-4.
6. Miller F, Liang Y, Merlo M, Harcke HT. Measuring anteversion and femoral neck-shaft angle in cerebral palsy. Dev Med Child Neurol 1997;39:113-8.
7. Laplaza FJ, Root L. Femoral anteversion and neck-shaft angles in hip instability in cerebral palsy. J Pediatr Orthop 1994;14:719-23.
8. LaGasse DJ, Staheli LT. The measurement of femoral anteversion. A comparison of the fluoroscopic and biplane roentgenographic methods of measurement. Clin Orthop Relat Res 1972;86:13-5.
9. Perlmutter MN, Synder M, Miller F, Bisbal R. Proximal femoral resection for older children with spastic hip disease. Dev Med Child Neurol 1993;35:525-31.
10. Kolban M. Variability of the femoral head and neck antetorsion angle in ultrasonographic measurements of healthy children and in selected diseases with hip disorders treated surgically. Ann Acad Med Stetin 1999;Suppl 51:1-99.
11. Elke R, Ebneter A, Dick W, Fliegel C, Morscher E. Ultrasound measurement of femur neck anteversion. Z Orthop Ihre Grenzgeb 1991;129:156-63. [Abstract]
12. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. AJR Am J Roentgenol 1997;168:791-4.
13. Rethlefsen SA, Healy BS, Wren TA, Skaggs DL, Kay RM. Causes of intoeing gait in children with cerebral palsy. J Bone Joint Surg [Am] 2006;88:2175-80.
14. Cooke PH, Carey RP, Williams PF. Lower femoral osteotomy in cerebral palsy: brief report. J Bone Joint Surg [Br] 1989;71:146-7.
15. Kay RM, Rethlefsen SA, Hale JM, Skaggs DL, Tolo VT. Comparison of proximal and distal rotational femoral osteotomy in children with cerebral palsy. J Pediatr Orthop 2003;23:150-4.
16. Mylle J, Lammens J, Fabry G. Derotation osteotomy to correct rotational deformities of the lower extremities in children. A comparison of three methods. Acta Orthop Belg 1993;59:287-92.
17. Lampropulos M, Puigdevall MH, Zapozko D, Malvárez HR. Proximal femoral resection and articulated hip distraction with an external fixator for the treatment of painful spastic hip dislocations in pediatric patients with spastic quadriplegia. J Pediatr Orthop B 2008;17:27-31.
18. Stout JL, Gage JR, Schwartz MH, Novacheck TF. Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. J Bone Joint Surg [Am] 2008;90:2470-84.
19. Klatt J, Stevens PM. Guided growth for fixed knee flexion deformity. J Pediatr Orthop 2008;28:626-31.
20. Ferri-de-Barros F, İnan M, Miller F. Intramedullary nail fixation of femoral and tibial percutaneous rotational osteotomy in skeletally mature adolescents with cerebral palsy. J Pediatr Orthop 2006;26:115-8.
21. Guidera KJ, Ganey TM, Keneally CR, Ogden JA. The embryology of lower-extremity torsion. Clin Orthop Relat Res 1994;(302):17-21.
22. Knight RA. Developmental deformities of the lower extremities. J Bone Joint Surg [Am] 1954;36:521-7.
23. Bruce RW Jr. Torsional and angular deformities. Pediatr Clin North Am 1996;43:867-81.
24. Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg [Am] 1985;67:39-47.
25. Price CT. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg [Am] 1985;67:823-4.
26. Stanton RP. Torsional variations in the lower extremities of normal children. Del Med J 1993;65:313-6.
27. Stefko RM, de Swart RJ, Dodgin DA, Wyatt MP, Kaufman KR, Sutherland DH, et al. Kinematic and kinetic analysis of distal derotational osteotomy of the leg in children with cerebral palsy. J Pediatr Orthop 1998;18:81-7.
28. Villani C, Billi A, Morico G, Calvisi V, Romanini L. Con- siderations on deformity of the foot and suprasegmental pathology in infantile cerebral palsy. Ital J Orthop Traumatol 1989;15:197-207.
29. Staheli LT. Torsion-treatment indications. Clin Orthop Relat Res 1989;(247):61-6.
30. El-Said NS. Osteotomy of the tibia for correction of complex deformity. J Bone Joint Surg [Br] 1999;81:780-2.
31. Steel HH, Sandrow RE, Sullivan PD. Complications of tibial osteotomy in children for genu varum or valgum. Evidence that neurological changes are due to ischemia. J Bone Joint Surg [Am] 1971;53:1629-35.
32. Dodgin DA, De Swart RJ, Stefko RM, Wenger DR, Ko JY. Distal tibial/fibular derotation osteotomy for correction of tibial torsion: review of technique and results in 63 cases. J Pediatr Orthop 1998;18:95-101.
33. McNicol D, Leong JC, Hsu LC. Supramalleolar derotation osteotomy for lateral tibial torsion and associated equinovarus deformity of the foot. J Bone Joint Surg [Br] 1983;65:166-70.
34. Selber P, Filho ER, Dallalana R, Pirpiris M, Nattrass GR, Graham HK. Supramalleolar derotation osteotomy of the tibia, with T plate fixation. Technique and results in patients with neuromuscular disease. J Bone Joint Surg [Br] 2004;86:1170-5.
35. Kempf I, Dagrenat D, Kloos M. Correction osteotomy and stabilization with the interlocking nail. Unfallchirurg 1990;93:499-505. [Abstract]
36. Rattey T, Hyndman J. Rotational osteotomies of the leg: tibia alone versus both tibia and fibula. J Pediatr Orthop 1994;14:615-8.
37. Manouel M, Johnson LO. The role of fibular osteotomy in rotational osteotomy of the distal tibia. J Pediatr Orthop 1994;14:611-4.
38. Banks SW, Evans EA. Simple transverse osteotomy and threaded-pin fixation for controlled correction of torsion deformities of the tibia. J Bone Joint Surg [Am] 1955; 37:193-5.
39. Payman KR, Patenall V, Borden P, Green T, Otsuka NY. Complications of tibial osteotomies in children with comorbidities. J Pediatr Orthop 2002;22:642-4.
40. İnan M, Ferri-de Baros F, Chan G, Dabney K, Miller F. Correction of rotational deformity of the tibia in cerebral palsy by percutaneous supramalleolar osteotomy. J Bone Joint Surg [Br] 2005;87:1411-5.
41. Ponseti IV, Becker JR. Congenital metatarsus adductus: the results of treatment. J Bone Joint Surg [Am] 1966;48:702-11.
42. Perry J. Pathologic gait. Instr Course Lect 1990;39:325-31.
43. Staheli LT. Medial femoral torsion. Orthop Clin North Am 1980;11:39-50.
44. Renshaw TS, Deluca PA. Cerebral palsy. In: Morrissy RT, Weinstein SL, editors. Lovell and Winter’s pediatric orthopaedics. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 551-604.