Zusammenfassung
Hintergrund
Die infantile Zerebralparese ist eine der häufigsten Erkrankungen mit der Folge einer chronischen Behinderung, die meist mit einer Beeinträchtigung der Gehfähigkeit einhergeht.
Erkrankungsmuster
Typischerweise entwickeln sich während des Wachstums Muskelverkürzungen mit nachfolgenden Gelenkkontrakturen und -instabilitäten sowie knöcherne Deformitäten in unterschiedlicher Ausprägung. Aus biomechanischer Sicht liegt der Gehbehinderung eine Hebelarmdysfunktion zugrunde.
Therapiestrategien
Das Therapiekonzept ist multimodal und umfasst konservative sowie operative Maßnahmen. Ziel ist es, den Muskeltonus zu senken, Muskel- und Gelenkkontrakturen sowie knöcherne Deformitäten zu vermeiden bzw. bereits fixierte Fehlstellungen zu korrigieren, um eine bestmögliche Funktion für den Patienten zu erzielen; dazu sind häufig aufwendige Multilevel-Operationen notwendig.
Schlussfolgerung
Für die Durchführung der Operationen sind fundierte Kenntnisse über die Biomechanik des Gehens sowie die Pathobiomechanik der spastischen bilateralen Zerebralparese erforderlich. Mithilfe der instrumentellen Ganganalyse können die biomechanischen Verhältnisse besser analysiert und aufwendige Operationen mit einer höheren Präzision geplant werden.
Abstract
Background
Infantile cerebral palsy is one of the most common diseases resulting in chronic disability and is mostly concomitant with impairment in the ability to walk.
Disease pattern
Muscle contractions typically develop during the growth phase with subsequent joint contracture and instability as well as bone deformities to various extents. From a biomechanical viewpoint the gait impairment is due to a lever arm dysfunction.
Therapeutic strategies
The therapy concept is multimodal and involves conservative as well as operative measures. The objectives are to lower the muscle tonus, to avoid muscle and joint contractures and bone deformities and to correct already fixed malformations in order to achieve the best possible function for the patient. Complicated multilevel operations are often necessary to achieve this aim.
Conclusion
Extensive knowledge on the biomechanics of gait and the pathobiomechanics of spastic bilateral cerebral palsy are necessary to carry out surgery. Using instrumental gait analyses the biomechanical relationships can be analyzed better and complicated operations can be planned with greater precision.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. B. Westhoff weist auf folgende Beziehungen hin: Referententätigkeit für die Fa. Ipsen-Pharma GmbH, Beratertätigkeit für die Fa. Pharm-Allergan GmbH. D. Bittersohl und R. Krauspe geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Westhoff, B., Bittersohl, D. & Krauspe, R. Bilaterale spastische Parese mit Gehfähigkeit (Diparese). Orthopäde 43, 656–664 (2014). https://doi.org/10.1007/s00132-013-2220-z
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DOI: https://doi.org/10.1007/s00132-013-2220-z