Spastik üst ekstremitede cerrahi tedavi: Tendon transferi uygulamaları

Beyin felcine bağlı üst ekstremite deformiteleri, spastik ve güçsüz kaslar arasındaki dengesizliğin stabil olmayan eklemlere etki etmesi sonucunda meydana gelir. Bu olgularda spastik el ve üst ekstremitelerin cerrahi tedavisindeki temel amaçlar, spastik kasların kuvvetinin azaltılması, antagonist kasların güçlendirilmesi ve stabil olmayan eklemlerin kalıcı stabilizasyonları olarak özetlenebilir. Bu amaçları yerine getirebilecek cerrahi teknik yelpaze ise, spastik kasların uzatılması, tendon transferleri, eklem kapsülünün serbestleştirilmesi veya plikasyonu, eklem artrodezleri, nörektomiler ve cilt prosedürlerinden oluşmaktadır. Bu yazıda, cerrahi tedavi seçenekleri ve uygulamaları arasında, özellikle dengenin sağlanması ve motor fonksiyonların cerrahi restorasyonunu sağlayan tendon transferleri ön planda sunulmaktadır.

Anahtar Kelimeler:

Ön kol, Üst ekstremite, Tendon transferi, Kontraktür, Çocuk, Beyin felci, Hasta seçimi, El deformasyonları, edinsel, Ortopedik işlemler, Kas spastisitesi

Tendon transfers for the upper extremity in cerebral palsy

Upper extremity deformities in cerebral palsy are caused by the imbalance between spastic and weak muscles acting on unstable joints. The basic goals of surgical treatment of spastic hands and upper extremities of patients with cerebral palsy can be summarized as reducing the strength of spastic muscles, strengthening the antagonist muscles, and permanent stabilization of unstable joints. Surgical techniques to achieve these goals include lengthening of spastic muscles, tendon transfers, release or plication of the joint capsule, joint arthrodesis, neurectomies, and skin procedures. Amongst these surgical treatment options, this article will present, in more detail, tendon transfers which are performed especially to achieve balance and restore motor functions.

Keywords:

Forearm, Upper Extremity, Tendon Transfer, Contracture, Child, Cerebral Palsy, Patient Selection, Hand Deformities, Acquired, Orthopedic Procedures, Muscle Spasticity,

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