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Das operative Management bei spastischen Fußdeformitäten

The surgical management of spastic foot deformities

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Zusammenfassung

Die operative Behandlung von Fußdeformitäten bei der spastischen Zerebralparese erfordert die sorgfältige Analyse aller Aspekte der Deformität nach den ihr zugrunde liegenden Deformierungsmechanismen und ihren funktionellen Auswirkungen. Operative Verfahren haben die Ziele, die Deformität zu korrigieren, die Stabilität des Fußes zu sichern, die funktionell wichtigen Bewegungsumfänge wiederherzustellen und die Muskelkraft möglichst wenig zu beeinträchtigen. Dazu sind vielfach Kombinationen aus mehreren Operationstechniken erforderlich. Zusätzlich müssen immer auch die Störungen bzw. Deformitäten der proximalen Gelenke in den Behandlungsplan mit einbezogen werden, da eine plantigrade Fußstellung nur bei lotrechter Beinstellung möglich ist. So stellt die Operation spastischer Fußdeformitäten oft nur einen Teilaspekt im operativen Gesamtprogramm dar. Dies ist auch bei der Beurteilung postoperativer Ergebnisse zu berücksichtigen. Durch die Einführung dynamischer Messverfahren wird es in Zukunft möglich sein, die funktionellen Auswirkungen der Deformitäten besser zu objektivieren.

Abstract

Any surgical treatment of spastic foot deformities must be preceded by an exact preoperative analysis of every aspect of the deformity and its functional consequences. The goals of surgical treatment are correction of the deformity, reestablishment of the stability of the foot and preservation of functionally important ranges of motion and muscle strength. These goals can usually be achieved only by a package of several simultaneous procedures. The foot must never be treated in isolation. Proximal joints have to be considered as well as the opposite side, because a plantigrade position of the foot is only possible when the leg is straight. Any postoperative evaluation must also take into account the proximal joints and the opposite leg in unilateral cases. The mere static evaluation of the postoperative results by reporting clinical and radiographic values should be supplemented by dynamic measurements which allow more insight into the functional results.

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  1. Abteilung Orthopädie und Rehabilitation, Stiftung Orthopädische Universitätsklinik Heidelberg

    L. Döderlein

  2. Abteilung Orthopädie und Rehabilitation, Stiftung Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200 a, 69118, Heidelberg

    L. Döderlein

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Döderlein, L. Das operative Management bei spastischen Fußdeformitäten. Orthopäde 33, 1152–1162 (2004). https://doi.org/10.1007/s00132-004-0683-7

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  • DOI: https://doi.org/10.1007/s00132-004-0683-7

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