Orthopädische Behandlung bei Myelomeningozele

 

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Zusammenfassung

Hintergrund: Es werden immer weniger Kinder mit Myelomeningozele (MMC) geboren, die dank der erreichten Fortschritte bei der Behandlung und infolge der verbesserten Fürsorge das Erwachsenenalter erreichen und orthopädisch betreut werden müssen. Die orthopädische Behandlung zielt auf die Verbesserung oder den Erhalt der Funktion und muss interdisziplinär erfolgen. Methode: In dieser Übersichtsarbeit werden die aktuellen in der Literatur empfohlenen orthopädietechnischen und operativen Therapiekonzepte dargestellt. Diese Darstellung erfolgt im Kontext funktioneller Aspekte in einzelnen für die motorische Entwicklung wichtigen Lebensabschnitten. Orthopädisches Behandlungskonzept: In den ersten 2 Lebensjahren muss vor allem die Mobilität der Kinder mit MMC durch die Kombination von Physiotherapie und optimaler Orthesenversorgung gefördert werden. Danach richtet sich die Orthesenversorgung nach der Muskelkraft, entstehenden Fehlstellungen, assoziierten ZNS-Fehlbildungen, Shunt-Komplikationen, Adipositas, Perzeptions- und Propriozeptionseinschränkungen und der Motivation und den Erwartungen der Kinder und Eltern/Betreuer. Orthopädische Operationen werden zum Erhalt der Orthesenfähigkeit und zur Vermeidung von Druckstellen mit möglichst kurzer Immobilisationsphase durchgeführt. Pathologische Frakturen sind nicht selten. Bei Verdacht ist eine röntgenologische Diagnostik indiziert, um zusätzliche Deformitäten durch zügige Behandlung zu vermeiden. Schlussfolgerung: Das Ziel der orthopädischen Behandlung besteht in der Vermeidung der Progredienz der primären muskuloskeletalen Veränderungen und der Sekundärschäden. Durch die interdisziplinäre Zusammenarbeit aller Behandler kann eine Funktionsverbesserung oder der Erhalt durch orthopädische Maßnahmen erreicht werden.

Abstract

Background: Due to prenatal diagnostic and folic acid prophylaxis less children with myelomeningocele are now being born. But they become older and need increasingly more orthopaedic care. The orthopaedic care is aimed at the improvement or the preservation of function. Method: In this review the current knowledge from the literature and our approach are presented. This is done in the context of the functional aspects within certain periods of life. Treatment Concept: In the first two years of life, the mobility of MMC children is supported by physiotherapy and orthoses irrespective of the level of the lesion. Afterwards, the optimal orthoses are chosen depending on the muscle power, emerging bone deformities, associated CNS malformation, shunt revisions, obesity and limitations in perception as well as the childʼs motivation. At school age, it is paramount to encourage independence. Orthotic treatment should be continued as long as the children benefit from it. Orthopaedic operations serve the orthosis fitting and the avoidance of pressure sores. Pathological fractures are common. They should be rapidly recognised in order to avoid further bony deformities. Conclusion: The aim of any orthopaedic treatment consists of the avoidance of musculoskeletal deformities in order to support the patientʼs self employment.

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