Abstract
The author presents indications and, where applicable, contraindications of orthopaedic surgery in children and adolescents with cerebral palsy, taking into account the types of cerebral palsy and the level of developmental Vojta stage. In our Department of Orthopaedic Surgery, 2nd Medical School of Charles University, University Hospital Motol we have operated 1763 patients with cerebral palsy in the period of 1992-2005, the total number of operations performed being 6833.
Surgical approaches include isolated and combined procedures on muscles and bones. It is necessary to take into account the interdependence of the foot, ankle, knee, hip, and trunk.
The ankle, knee, and hip should be treated as one functional unit. The increasing incidence of neurogenic subluxation or dislocation of the hip joint in patients with cerebral palsy results in combined surgeries on muscles and bones.
Surgical approaches in the hip area include isolated and combined procedures on muscles (adductors and flexors, hamstring) and isolated and combined procedures on bones and joint (open reposition, proximal femoral osteotomy, acetabuloplasty, pelvic osteotomy, paliative operation in the hip area). The area of the knee involves a knee flexion deformity and high position of the patela.
The main operation in this area is hamstring lengthening. Strayer procedure should be used preferably, in order to avoid inadvertent lengthtening of the Achilles tendon and pes calcaneus deformities.
Grice extraarticular arthrodesis is one of basic static operation to stabilize the foot. The autor presents basic therapeutic principles for procedures in the area of spine and upper extremities in patients with cerebral palsy.