Riad Jacques, Haglund-Akerlind Yvonne, Miller Freeman
Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
J Pediatr Orthop. 2007 Oct-Nov;27(7):758-64. doi: 10.1097/BPO.0b013e3181558a15.
The Winter classification of spastic hemiplegic cerebral palsy (CP) is based on sagittal kinematic data from 3-dimensional gait analysis used in preoperative decision making and postoperative evaluation. Our goal was to investigate how well children with spastic hemiplegic CP can be classified using Winter criteria. Second, we assessed if patients move between groups over time and/or with surgical intervention.
One hundred twelve patients with spastic hemiplegic CP with a mean age of 8.1 years were included. Medical records and the full gait analysis data were reviewed. Patients were classified using Winter criteria, and an independent sample t test was used to compare groups.
We found 26 patients (23%) that could not be classified according to Winter criteria. We defined these patients as group 0. This group showed the least deviation from normal values. Each of the 5 groups in our study showed a higher mean velocity of gait and were younger than any of the groups from the Winter study. In regard to rotational alignment, kinetic variables, and, to a certain extent, muscle tone, group 0 showed the least deviation from normal values; however, most differences were subtle. When reclassifying patients after a mean of 3 years, 8 of 15 had deteriorated in the nonsurgical group, moving to a higher numbered group, whereas 19 of 31 surgically treated patients had improved.
The Winter classification failed to classify 23% (26/112) of our spastic hemiplegic CP children. We suggest that the classification be complemented with the less involved group 0. In this way, all patients can be classified, and thus, treatment plans can be established for all patients. The classification can be divided into ankle, knee, and hip joint involvement. The ankle involvement can be further divided into 3 separate groups. Treating physicians should be aware of the possibility that patients may move into another classification group over time.
Diagnostic level 4. See instructions to authors for a complete description of levels of evidence.
痉挛性偏瘫型脑瘫（CP）的温特分类基于术前决策和术后评估中使用的三维步态分析的矢状面运动学数据。我们的目标是研究使用温特标准对痉挛性偏瘫型CP儿童进行分类的效果如何。其次，我们评估了患者是否会随着时间推移和/或通过手术干预在不同组别之间转换。
纳入112例痉挛性偏瘫型CP患儿，平均年龄8.1岁。回顾病历和完整的步态分析数据。使用温特标准对患者进行分类，并采用独立样本t检验比较各组。
我们发现26例患者（23%）无法根据温特标准进行分类。我们将这些患者定义为0组。该组与正常值的偏差最小。我们研究中的5个组每组的平均步态速度均较高，且比温特研究中的任何一组都更年轻。在旋转对线、动力学变量以及在一定程度上的肌张力方面，0组与正常值的偏差最小；然而，大多数差异都很细微。在平均3年后对患者重新分类时，非手术组的15例中有8例病情恶化，转移到更高编号的组，而31例接受手术治疗的患者中有19例病情改善。
温特分类未能对我们23%（26/112）的痉挛性偏瘫型CP儿童进行分类。我们建议用参与程度较低的0组对该分类进行补充。通过这种方式，所有患者都能被分类，从而可以为所有患者制定治疗计划。该分类可分为踝关节、膝关节和髋关节受累情况。踝关节受累可进一步分为3个独立的组。治疗医生应意识到患者可能会随着时间推移进入另一个分类组。
诊断性4级。有关证据水平的完整描述，请参阅作者指南。
