Brunner R
Abt. Neuroorthopädie, Univ.-Kinderspital beider Basel, Spitalstraße 33, 4005, Basel, Schweiz,
Orthopade. 2014 Jul;43(7):643-8. doi: 10.1007/s00132-013-2218-6.
In patients with cerebral palsy who are able to walk the source of the problem of spasticity must first be correctly determined. The weakness appears to be the main problem and the first line treatment must concentrate on improvement of strength and bodily control.
Spasticity can also compensate for weaknesses. The indications for weakening measures for correction of muscle tonus must therefore be carefully appraised but are part of the repertoire. Orthoses result in stability and correction of deformities. Night braces are in our experience of doubtful value. Biomechanical objectives are a right-angle between the sole of the shoe and lower leg axis (leading edge of the tibia) and full passive and active extension in the knees and hips.
Severely handicapped patients often suffer from hip luxation and scoliosis. Regular control of the hips and spine under loading are necessary. Early interventions, conservative and operative, have a better prognosis than a late correction. In general patients who have a risk for deformities and dysfunction of the musculoskeletal system due to the underlying disease should undergo early orthopedic control.
在能够行走的脑瘫患者中，必须首先正确确定痉挛问题的根源。虚弱似乎是主要问题，一线治疗必须集中于增强力量和身体控制能力。
痉挛也可以代偿虚弱。因此，对于纠正肌肉张力的减弱措施的适应证必须仔细评估，但这也是治疗方法之一。矫形器可实现稳定并矫正畸形。根据我们的经验，夜间支具有可疑的价值。生物力学目标是鞋底与小腿轴线（胫骨前缘）呈直角，以及膝关节和髋关节完全被动和主动伸展。
重度残疾患者常患有髋关节脱位和脊柱侧弯。在负重情况下定期检查髋部和脊柱很有必要。早期干预，包括保守和手术治疗，比晚期矫正预后更好。一般来说，因基础疾病有肌肉骨骼系统畸形和功能障碍风险的患者应尽早接受骨科检查。
