术前步态分析对脑瘫患儿的骨科决策有重大影响：60例患者临床评估与步态分析的比较

Preoperative gait analysis has a substantial effect on orthopedic decision making in children with cerebral palsy: comparison between clinical evaluation and gait analysis in 60 patients.

作者信息

Lofterød Bjørn, Terjesen Terje, Skaaret Ingrid, Huse Ann-Britt, Jahnsen Reidun

机构信息

Section for Child Neurology, Rikshospitalet University Hospital, Oslo, Norway.

出版信息

Acta Orthop. 2007 Feb;78(1):74-80. doi: 10.1080/17453670610013448.

DOI:10.1080/17453670610013448

PMID:17453395

Abstract

BACKGROUND

There is still some debate regarding the role of 3-dimensional gait analysis in routine preoperative evaluation of children with cerebral palsy. The aim of this prospective study was to evaluate to what extent introduction of 3-D gait analysis changes preoperative surgical planning.

METHOD

Before gait analysis, 60 ambulatory children aged 10 (4-18) years with spastic cerebral palsy had a specific surgical plan outlined, based on clinical examination by orthopedic surgeons. After gait analysis, the proposed surgical procedures were reviewed to determine the frequency with which the treatment plans changed. A multidisciplinary team assessed the gait analysis.

RESULTS

Treatment plans for 42 of the 60 patients were altered after gait analysis. Surgical treatment was recommended for 49 patients whereas 11 were recommended non-surgical treatment. Of the 253 specific surgical procedures proposed, 97 procedures were not recommended after gait analysis and 65 additional procedures were recommended after the analysis. Thus, the number of procedures proposed was reduced by 13%. A total of 318 specific surgical procedures were proposed either clinically, by gait analysis, or both. There was overall agreement between the referring orthopedic surgeons and gait analysis in 156 of these 318 procedures (49%). Gait analysis proposed more surgery for psoas tenotomy and rectus femoris transfer, whereas less surgery was proposed for other soft tissue and bony procedures. There was good accordance between gait analysis recommendations and the surgery performed subsequently (92%).

INTERPRETATION

Gait analysis provided important additional information that modified preoperative surgical planning to a high degree. The high accordance between recommendations and surgery performed suggests that surgeons seriously consider the gait data and treatment recommendations.

摘要

背景

关于三维步态分析在脑瘫患儿常规术前评估中的作用仍存在一些争议。这项前瞻性研究的目的是评估三维步态分析在多大程度上改变术前手术规划。

方法

在进行步态分析之前，60名年龄在10（4 - 18）岁的痉挛性脑瘫门诊患儿，由骨科医生根据临床检查制定了具体的手术方案。在步态分析之后，对提议的手术程序进行审查，以确定治疗计划改变的频率。一个多学科团队对步态分析进行了评估。

结果

60例患者中有42例在步态分析后治疗计划发生了改变。建议对49例患者进行手术治疗，而对11例建议非手术治疗。在提议的253项具体手术程序中，步态分析后97项程序未被推荐，另有65项程序在分析后被推荐。因此，提议的程序数量减少了13%。通过临床、步态分析或两者共提出了318项具体手术程序。在这318项程序中，转诊的骨科医生与步态分析之间总体一致性为156项（49%）。步态分析建议更多地进行腰大肌切断术和股直肌转移术，但对其他软组织和骨手术的建议较少。步态分析建议与随后进行的手术之间有很好的一致性（92%）。