Proximale Femurosteotomien im Wachstumsalter: Wann indiziert? Wie operieren?

Zusammenfassung

Proximale Femurosteotomien sind in der Kinderorthopädie ein häufiger Eingriff zur Korrektur hüftgelenksnaher Deformitäten. Ziel der proximalen Femurosteotomien ist i. d. R. die Optimierung des Containments der Hüfte durch Varisierung oder Valgisierung, Extension oder Flexion mit ggf. begleitender Verkürzung, Verlängerung oder Derotation. Weitere operative Ziele sind die Verbesserung einer möglichen muskulären Dysbalance durch Optimierung des femoralen Offsets, Erweiterung des Bewegungsumfangs und Schmerzreduktion. Langfristig gilt es, durch die proximale Femurosteotomie den Progress einer frühzeitigen Koxarthrose zu minimieren. In der Literatur ist die Bandbreite der beschriebenen proximalen Femurosteotomien groß. Grob lassen sie sich anhand ihrer anatomischen Lokalisation in subkapital, basozervikal, intertrochantär und subtrochantär unterteilen. Zur richtigen Wahl des operativen Verfahrens ist ein profundes Wissen über die Genese der Erkrankung und Indikationsstellung notwendig. Ziel der vorliegenden Literaturübersicht ist es, anhand einer selektiven Literaturrecherche die unterschiedlichen Osteotomieverfahren am proximalen Femur sowie ihre Indikationen darzustellen. Zusätzlich zeigt sich in den letzten Jahren ein Wechsel hinsichtlich des verwendeten Osteosyntheseverfahrens hin zu winkelstabilen Implantaten. Aufgrund der Winkelstabilität entfällt i. d. R. die postoperative Ruhigstellung im Becken-Bein-Gips und erleichtert somit dem jungen Patienten eine zügige Remobilisation.

Schlüsselwörter

proximale Femurosteotomie - Hüftdeformitäten - Kinderorthopädie - Wachstumsalter

Publication History

Article published online:
27 November 2019

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