SPASTIC QUADRIPLEGIC CEREBRAL PALSY WITH EXPOSED MALUNION BONE AT BILATERAL PROXIMAL HUMERUS AND DISTAL FEMUR
DOI:
https://doi.org/10.31004/prepotif.v10i1.53513Keywords:
cerebral palsy, malunion, exposed bone, quadriplegic, osteotomyAbstract
Anak dengan cerebral palsy berisiko mengalami fraktur kerapuhan akibat rendahnya densitas tulang yang disebabkan oleh berbagai etiologi. Status ambulasi pada pasien cerebral palsy merupakan salah satu faktor yang dapat memengaruhi densitas tulang. Penatalaksanaan fraktur pada kondisi ini sering kali berakhir dengan malunion, baik dengan terapi non-operatif maupun operatif. Spastic quadriplegic cerebral palsy (SQCP) merupakan tipe yang berat, menyebabkan kelumpuhan dan kekakuan otot pada kedua lengan dan tungkai, serta dapat memperberat proses penyembuhan fraktur tulang. Seorang gadis berusia 9 tahun telah mengeluhkan luka terbuka di bahu kanan dan kiri serta lutut kiri sejak 4 bulan yang lalu. Pemeriksaan radiografis pada kedua bahu dan lutut menunjukkan malunion pada humerus proksimal bilateral dan femur distal kiri. Pasien didiagnosis menderita cerebral palsy spastik quadriplegia GMFCS V dengan tulang malunion yang terekspos pada humerus proksimal bilateral dan femur distal. Kemudian ia diobati dengan antibiotik ampicillin sulbactam, luka dibersihkan (debridement), dilakukan osteotomi, dan penutupan luka primer. Penderita cerebral palsy GMFCS IV dan V memiliki insidensi fraktur tulang yang lebih tinggi, dan hal ini terkait langsung dengan densitas mineral tulang (BMD). Beban mekanis, baik akibat kontraksi otot maupun beban gravitasi, menyebabkan deformasi tulang dan meningkatkan kekuatan tulang. Spastisitas ditandai dengan peningkatan tonus otot, refleks yang hiperaktif, dan kehilangan gerakan sendi yang menyebabkan kontraktur.References
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