Metaxiotis D, Wolf S, Doederlein L
Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200A, 69118 Heidelberg, Germany.
J Bone Joint Surg Br. 2004 Jan;86(1):102-9.
We treated 20 children (40 limbs) with diplegic cerebral palsy who could walk by multilevel soft tissue operative procedures including conversion of the biarticular semitendinosus and gastrocnemius to monoarticular muscles. The mean age at surgery was 11.5 years (5.6 to 17.0). All patients underwent clinical and radiological examination and three-dimensional instrumented gait analysis before and at a mean of 3.1 years (2.0 to 4.5) after surgery. The passive range of movement at the ankle, knee and hip showed improvement at follow-up. Kinematic parameters indicated a reduced pelvic range of movement and improvement of extension of the knee in single stance after operation (p < 0.0001). However, post-operative back-kneeing was detected in five of the 40 limbs. The kinetic studies showed that the power of the hamstrings and plantar flexors of the ankle was maintained while the maximum knee extensor moment during stance was reduced. The elimination of knee flexor activity of semitendinosus and gastrocnemius combined with transfer of distal rectus femoris led to an improvement in gait as confirmed by gait analysis.
我们对20例（40条肢体）双瘫型脑瘫且能够行走的儿童进行了多级软组织手术治疗，包括将双关节半腱肌和腓肠肌转变为单关节肌肉。手术时的平均年龄为11.5岁（5.6至17.0岁）。所有患者在手术前以及术后平均3.1年（2.0至4.5年）时均接受了临床和放射学检查以及三维步态分析。随访时，踝关节、膝关节和髋关节的被动活动范围均有改善。运动学参数表明，术后骨盆活动范围减小，单腿站立时膝关节伸展改善（p < 0.0001）。然而，在40条肢体中有5条出现了术后膝反张。动力学研究表明，腘绳肌和踝关节跖屈肌的力量得以维持，而立位时膝关节最大伸展力矩减小。半腱肌和腓肠肌的屈膝活动消除，同时股直肌远端转移，步态分析证实步态得到改善。
