Gough Martin, Eve Linda C, Robinson Richard O, Shortland Adam P
One Small Step Gait Laboratory, Guy's Hospital, London SE1 9RT, UK.
Dev Med Child Neurol. 2004 Feb;46(2):91-7. doi: 10.1017/s0012162204000192.
Outcome in 24 ambulant children with spastic diplegic cerebral palsy, in whom multilevel surgical intervention was recommended following gait analysis, is reviewed. Twelve children had surgical intervention (treatment group; eight males, four females; mean age 9 years 10 months, SD 3 years 4 months) while the other 12 did not (control group; five males, seven females; mean age 10 years 1 month, SD 2 years 11 months). All children had interval three-dimensional gait analyses (mean time between analyses: control group, 14.1 months; treatment group, 17.9 months). At follow-up the control group (mean age 11 years 9 months) showed a significant increase in minimum hip and knee flexion in stance which was not related to age, the interval between analyses, changes in the passive joint range of motion, nor changes in anthropometric measurements. The treatment group (mean age at follow-up 11 years 3 months) showed a significant improvement in minimum knee flexion and in ankle dorsiflexion in stance. Parents of nine children said their child's walking distance had increased following intervention. Of five children using posterior walkers preoperatively, two continued to use them postoperatively; two were using crutches or sticks and the remaining child walked independently. Two children who walked independently preoperatively used sticks postoperatively for community ambulation. The deterioration seen in the kinematics of the control group suggests that previous outcome studies comparing postoperative gait with preoperative gait have underestimated the immediate effects of surgery. It also raises concerns about the long-term effects of surgical intervention.
回顾了24例痉挛型双瘫脑瘫患儿的治疗结果，这些患儿在步态分析后被建议进行多级手术干预。12名儿童接受了手术干预（治疗组；8名男性，4名女性；平均年龄9岁10个月，标准差3岁4个月），而另外12名儿童未接受手术干预（对照组；5名男性，7名女性；平均年龄10岁1个月，标准差2岁11个月）。所有儿童均进行了间隔三维步态分析（分析之间的平均时间：对照组14.1个月；治疗组17.9个月）。随访时，对照组（平均年龄11岁9个月）站立时最小髋关节和膝关节屈曲显著增加，这与年龄、分析间隔、被动关节活动范围的变化以及人体测量学测量的变化无关。治疗组（随访时平均年龄11岁3个月）站立时最小膝关节屈曲和踝关节背屈有显著改善。9名儿童的家长表示，干预后他们孩子的行走距离增加了。术前使用后助行器的5名儿童中，2名术后继续使用；2名使用拐杖，其余儿童独立行走。术前独立行走的2名儿童术后在社区行走时使用拐杖。对照组运动学方面出现的恶化表明，以前比较术后步态与术前步态的结果研究低估了手术的即时效果。这也引发了对手术干预长期效果的担忧。
