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Das Kniegelenk bei der Zerebralparese

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Infantile Zerebralparese

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Zusammenfassung

Das Kniegelenk spielt eine zentrale Rolle beim spastisch-pathologischen Gang. Wegen der langen Hebelarme zieht jede Kniegelenkdeformität charakteristische Gangstörungen nach sich, die, wenn sie einseitig sind, immer auf der Gegenseite kompensiert werden müssen. Unter den Pathomechanismen stehen die pathologische Musteraktivität und die Muskelschwäche ganz im Vordergrund. Die instrumentelle Ganganalyse nimmt gerade auch bei den Knieproblemen einen wichtigen Stellenwert für die Therapieindikation ein. Bei der Behandlung kommt den konservativen Maßnahmen vielfach nur eine untergeordnete bzw. additive Bedeutung zu. Die operative Therapie ist weitgehend von muskelverlängernden Verfahren abgerückt, da durch jede Muskelverlängerung die Kraft weiter sinkt. Knöcherne Korrekturen haben das Ziel, die Hebelverhältnisse zu normalisieren und die Muskelspannung zu verbessern. Bei jeder Kniegelenkdeformität müssen auch die Auswirkungen der kniegelenküberschreitenden langen Muskeln auf die Nachbargelenke berücksichtigt werden. Beim stärker Behinderten bestehen mit jeder zunehmenden Kniegelenkdeformierung ebenfalls Therapieindikationen, um die Transfer-, die Sitz- und die Liegefunktionen zu verbessern. Auch hier ist jedoch vor unkritischen Muskelschwächungen zu warnen. Alle operativen Maßnahmen werden zumindest vorübergehend mit konservativer Orthesentechnik kombiniert, um die Therapieeffekte bei fortbestehenden pathologischen Mustern zu erhalten.

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Authors and Affiliations

  1. Orthopädische Kinderklinik, Behandlungszentrum Aschau GmbH, Orthopädische Kinderklinik, Aschau im Chiemgau, Deutschland

    Leonhard Döderlein

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  1. Leonhard Döderlein
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Correspondence to Leonhard Döderlein .

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Döderlein, L. (2015). Das Kniegelenk bei der Zerebralparese. In: Infantile Zerebralparese. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35319-2_11

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  • DOI: https://doi.org/10.1007/978-3-642-35319-2_11

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-35318-5

  • Online ISBN: 978-3-642-35319-2

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