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DOI: 10.1055/s-0044-1786541
Tratamiento de la contractura en flexión de rodilla en parálisis cerebral
Article in several languages: español | EnglishResumen
La extensión completa de la rodilla es esencial para la marcha. Los pacientes con parálisis cerebral infantil con frecuencia pueden tener déficit de extensión de distinta magnitud, lo que compromete la marcha e incluso la bipedestación. El tratamiento de la contractura en flexión de rodilla parte por tratar la espasticidad de los músculos comprometidos y con fisioterapia. Cuando el flexo es estructurado, el tratamiento es quirúrgico mediante distintas técnicas, dependiendo de la magnitud de la contractura y de la edad del paciente. Las técnicas sobre partes blandas incluyen alargamientos funcionales de isquiotibiales y transferencias musculares. Cuando la contractura es capsular, es preferible realizar cirugía ósea, la cual extiende el fémur proximal, ya sea en forma progresiva, mediante fisiodesis anterior en pacientes pediátricos, o en forma aguda, mediante osteotomía extensora del fémur distal. Con frecuencia existe una patela alta, la cual hay que corregir en el mismo acto quirúrgico para mantener la eficiencia del aparato extensor.
Palabras clave
parálisis cerebral - rodilla - contractura - marcha - diplejía - isquiotibiales - patela altaPublication History
Received: 14 November 2023
Accepted: 01 April 2024
Article published online:
03 May 2024
© 2024. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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Referencias
- 1 Sutherland DH, Davids JR. Common gait abnormalities of the knee in cerebral palsy. Clin Orthop Relat Res 1993; (288) 139-147
- 2 Rodda JM, Graham HK, Carson L, Galea MP, Wolfe R. Sagittal gait patterns in spastic diplegia. J Bone Joint Surg Br 2004; 86 (02) 251-258
- 3 Ganjwala D, Shah H. Management of the knee problems in spastic cerebral palsy. Indian J Orthop 2019; 53 (01) 53-62
- 4 Arnold AS, Anderson FC, Pandy MG, Delp SL. Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a framework for investigating the causes of crouch gait. J Biomech 2005; 38 (11) 2181-2189
- 5 Ounpuu S, Gage JR, Davis RB. Three-dimensional lower extremity joint kinetics in normal pediatric gait. J Pediatr Orthop 1991; 11 (03) 341-349
- 6 Kirtley C. Support and forward progression. In: Clinical gait analysis: theory and practice. London: Churchill Livingstone; 2006: 237-254
- 7 Horstmann HM, Bleck EE. Knee. In: Orthopaedic management in serebral palsy. 2nd ed.. London: Mac Keith Press; 2007: 303-343
- 8 Trost J. Physical assessment and observational gait analysis. In: Gage JR. editor. The treatment of gait problems in cerebral palsy. London: Mac Keith Press; 2004: 71-89
- 9 Temelli Y, Akalan NE. [Treatment approaches to flexion contractures of the knee]. Acta Orthop Traumatol Turc 2009; 43 (02) 113-120
- 10 Gage JR. Treatment principles for crouch gait. In: Gage JR. editor. The treatment of gait problems in cerebral palsy. London: Mac Keith Press; 2004: 382-397
- 11 Young JL, Rodda J, Selber P, Rutz E, Graham HK. Management of the knee in spastic diplegia: what is the dose?. Orthop Clin North Am 2010; 41 (04) 561-577
- 12 Sung KH, Chung CY, Lee KM. et al. Long term outcome of single event multilevel surgery in spastic diplegia with flexed knee gait. Gait Posture 2013; 37 (04) 536-541
- 13 De Mattos C, Patrick Do K, Pierce R, Feng J, Aiona M, Sussman M. Comparison of hamstring transfer with hamstring lengthening in ambulatory children with cerebral palsy: further follow-up. J Child Orthop 2014; 8 (06) 513-520
- 14 Rutz E, Gaston MS, Camathias C, Brunner R. Distal femoral osteotomy using the LCP pediatric condylar 90-degree plate in patients with neuromuscular disorders. J Pediatr Orthop 2012; 32 (03) 295-300
- 15 Das SP, Pradhan S, Ganesh S, Sahu PK, Mohanty RN, Das SK. Supracondylar femoral extension osteotomy and patellar tendon advancement in the management of persistent crouch gait in cerebral palsy. Indian J Orthop 2012; 46 (02) 221-228
- 16 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 (11) 2470-2484
- 17 Novacheck TF, Stout JL, Gage JR, Schwartz MH. Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. Surgical technique. J Bone Joint Surg Am 2009; 91 (Suppl. 02) 271-286
- 18 Ganjwala D. Multilevel orthopedic surgery for crouch gait in cerebral palsy: An evaluation using functional mobility and energy cost. Indian J Orthop 2011; 45 (04) 314-319
- 19 Taylor D, Connor J, Church C. et al. The effectiveness of posterior knee capsulotomies and knee extension osteotomies in crouched gait in children with cerebral palsy. J Pediatr Orthop B 2016; 25 (06) 543-550
- 20 Al-Aubaidi Z, Lundgaard B, Pedersen NW. Anterior distal femoral hemiepiphysiodesis in the treatment of fixed knee flexion contracture in neuromuscular patients. J Child Orthop 2012; 6 (04) 313-318
- 21 Klatt J, Stevens PM. Guided growth for fixed knee flexion deformity. J Pediatr Orthop 2008; 28 (06) 626-631
- 22 Long JT, Laron D, Garcia MC, McCarthy JJ. Screw Anterior Distal Femoral Hemiepiphysiodesis in Children With Cerebral Palsy and Knee Flexion Contractures: A Retrospective Case-control Study. J Pediatr Orthop 2020; 40 (09) e873-e879
- 23 Nazareth A, Gyorfi MJ, Rethlefsen SA, Wiseley B, Noonan K, Kay RM. Comparison of plate and screw constructs versus screws only for anterior distal femoral hemiepiphysiodesis in children. J Pediatr Orthop B 2020; 29 (01) 53-61