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Kinder- und Jugendmedizin 2007; 7(07): 407-413
DOI: 10.1055/s-0038-1625721
Kinderorthopädie
Schattauer GmbH

Neue Aspekte der orthopädischen Behandlung der infantilen Zerebralparese

New aspects in the orthopedic management of cerebral palsy
Leonhard Döderlein
1   Orthopädische Universitätsklinik Heidelberg, Abteilung Orthopädie II (Direktor: Prof. Dr. med. H. J. Gerner)
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Further Information

Publication History

Eingegangen: 06 July 2007

angenommen: 13 July 2007

Publication Date:
10 January 2018 (online)

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Zusammenfassung

Die orthopädische Behandlung der infantilen Zerebralparese war bisher durch die operative Korrektur struktureller Deformitäten gekennzeichnet. Die Verfahren bestanden zumeist aus Muskel- und Sehnenverlängerungen, gefolgt von Gipsruhigstellungen und anschließender Apparateversorgung. Das Resultat war in vielen Fällen zwar eine Korrektur, jedoch oftmals ohne funktionelle Verbesserung.

Durch die Einführung von Botulinumtoxin wurde die Forschung zur Zerebralparese aktiviert. Der spastische Muskel ist kürzer, schwächer und steifer, was zu einem Umdenken im konservativen wie auch im operativen Vorgehen führen muss. Jede Muskelverlängerung führt zu weiterer Schwächung, weshalb möglichst versucht werden muss, durch die Kombination konservativer Therapien die Muskellänge zu erhalten und Zeit zu gewinnen.

Unsere Kenntnis der gestörten Bewegung wurde durch die instrumentelle Ganganalyse, die eine objektive Dokumentation ermöglicht, wesentlich erweitert. Neue Wege zur Klassifizierung der Lähmungsbilder erlauben eine bessere Einteilung auch bezüglich der Therapieplanung und -kontrolle.

Zu den konservativen Behandlungsverfahren kamen neben Botulinumtoxin die Baclofenpumpe sowie neue Orthesenkonstruktionen hinzu. Auch auf dem Gebiet der Krankengymnastik zeichnet sich ein Wandel weg von klassischen Methoden hin zur zielorientierten Betrachtungsweise ab. Kräftigungsbehandlungen und laufbandgestützte Lokomotionstrainer haben dabei eine wichtige Bedeutung.

Summary

Orthopedic management of patients with cerebral palsy consisted until recently of surgical corrections of contractures and deformities followed by plaster-immobilisation. Although the legs were mostly straight the functional improvements remained only small.

The introduction of botulinum toxin A into the management of spastic disorders has given a tremendous input into further research on spasticity. The spastic muscle is short, stiff and weak. This fact should induce a change into our surgical strategy. Weakening procedures such as muscle or tendon lengthenings should be critically questioned. It would be advisable to prevent structural contractures as long as possible by deliberately combining conservative treatments including tone reduction, stretch, orthoses and strengthening. The introduction of computer based motion analysis systems has further enlarged our knowledge about spastic movement patterns. New classification systems allow us now to clearly define patient groups and to evaluate all aspects of the disability including quality of life measurements.

New conservative treatments should focus on muscle stretch, muscle strength and conditioning rather than relying on unproven theoretical issues. The inclusion of treadmill training can further improve walking disorders effectively.

Schlüsselwörter

Zerebralparese - Muskelspastik - Botulinumtoxin

Keywords

Cerebral palsy - spastic muscle - botulinum toxin
 

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