Liutkevich M. Surgical prophylaxis and treatment tactics of hip subluxation and dislocation in children with cerebral palsy

Object: subluxation and dislocation of the hip in children with cerebral palsy. The aim: improvement of methods of diagnosis and surgical treatment of subluxation and dislocation of the hip in children with cerebral palsy, which will improve their quality of life. Methods: clinical, radiographic, math (finite element and grapho-analytical models), biomechanical, statistics. For the first time biomechanical mathematical models of functioning of the hip in children with cerebral palsy were developed. Multifactor estimation model overall status and prediction of hip joint pathology at cerebral palsy was created. New knowledge about the development of the components of the hip joint during subluxation and dislocation of the hip in children with cerebral palsy, before and after surgical treatment were received, structural features and the spatial orientation of the acetabulum were identified. For the first time working classification of therapeutic interventions for the prevention and treatment of spastic subluxation and dislocation of the hip in children with cerebral palsy has been established. For the first time the impact of position the femur had, muscular effort and the anatomical features of the hip joint on the state of his stress and deflection of the resultant force vector was studied using established finite element and the grapho-mathematical models. Application of comprehensive assessment of the hip joint allows to get prognostic, diagnostic and therapeutic criteria for the further development of the joint. It is confirmed that decentration is one of the first X-ray symptoms of subluxation and dislocation of the hip in children with cerebral palsy. Developed and introduced diagnostic and treatment algorithm for timely diagnosis, prediction and early surgical treatment of subluxation and dislocation of the hip in children with cerebral palsy, allows detect some pathological conditions in the hip joint in the early stages of their development and use of a unique set of therapeutic measures (conservative and surgical ) aimed at the recovery of the patient. Developed method of restoring ligament of the femoral head (Ukraine patent number 60569) in the case of dislocation of the hip in children with cerebral palsy, improves the reliability of the stabilization of the hip joint that can improve the results of treatment of these patients and therefore their quality of life. The proposed combination of treatment measures, including surgery, for the treatment of spastic hip subluxation and dislocation in different syndromes of hip joint disease and their combinations enables us to obtain the best anatomical and functional results in patients with this serious disease. Results of the study are introduced into clinical practice at SI "Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine", KLPZ " Chernihiv Regional Children's Hospital", KZOZ "Kharkiv Regional Children's Clinical Hospital", Utility Company "Odessa Regional Children's Clinical Hospital ", KZ LOR "Lviv Regional Children's Clinical Hospital "OKHMADET" и в educational process of profile departments of Kharkiv Medical Academy of Postgraduate Education Ministry of Health of Ukraine, Bogomolets National Medical University Ministry of Health of Ukraine, State Higher Educational Institution "Uzhhorod National University" Ministry of Education and Science of Ukraine. Traumatology and Orthopaedics.