Fry Nicola R, Gough Martin, McNee Anne E, Shortland Adam P
One Small Step Gait Laboratory, Guy's Hospital, London, UK.
J Pediatr Orthop. 2007 Oct-Nov;27(7):769-74. doi: 10.1097/BPO.0b013e3181558943.
Morphology is an important determinant of muscle force and power generation. Children with spastic diplegic cerebral palsy (SDCP) have reduced muscular strength, which in part is caused by inadequate muscle growth. There is a widespread concern that surgery to correct soft tissue deformities may exacerbate the underlying muscle weakness and further retard muscle growth. In this study, we compared measurements of medial gastrocnemius (MG) muscle morphology in typically developing (TD) children to those in children with SDCP with calf muscle deformities before and after corrective surgery.
We measured the length and volume of the MG muscle belly using 3-dimensional ultrasound immediately before and at 7 weeks and 1 year after vulpius procedure (VP) surgery in children with SDCP. We made similar measurements in a group of TD children. The SDCP group consisted of 7 children (6 boys, 1 girls; total of 8 limbs; age range, 6-10 years; mean 8 years 1 month, SD +/- 1 year 11 months) and the TD group consisted of 10 children (4 boys, 6 girls; age range, 6-12 years; mean, 9 years 5 months; SD +/- 2 years 6 months).
The children with SDCP presented with MG muscle bellies both smaller and shorter than the TD children even when normalized to body mass and limb length, respectively. Muscle belly length was reduced by surgery and remained unaltered 1 year later, despite skeletal growth. Muscle volume was not significantly changed 7 weeks after surgery, but increased significantly between 7 weeks and 1 year after surgery.
Children with SDCP presented with short and small MG when compared with TD children. Our results indicate that gastrocnemius muscle volume recovers within a year of VP surgery.
This study is the first to investigate the effects of surgery on muscle belly volume and length in the human subject. The study indicates that VP surgery is not an agent of long-term muscle atrophy in individuals with SDCP with plantarflexion deformities.
形态学是肌肉力量和功率产生的重要决定因素。痉挛性双侧瘫脑瘫（SDCP）患儿的肌肉力量降低，部分原因是肌肉生长不足。人们普遍担心，矫正软组织畸形的手术可能会加重潜在的肌肉无力，并进一步阻碍肌肉生长。在本研究中，我们比较了正常发育（TD）儿童与患有小腿肌肉畸形的SDCP患儿在矫正手术前后内侧腓肠肌（MG）的肌肉形态测量结果。
我们在SDCP患儿进行Vulpius手术（VP）前、术后7周和1年时，使用三维超声测量MG肌腹的长度和体积。我们对一组TD儿童进行了类似的测量。SDCP组由7名儿童组成（6名男孩，1名女孩；共8条肢体；年龄范围6 - 10岁；平均8岁1个月，标准差±1年11个月），TD组由10名儿童组成（4名男孩，6名女孩；年龄范围6 - 12岁；平均9岁5个月；标准差±2年6个月）。
即使分别根据体重和肢体长度进行标准化，SDCP患儿的MG肌腹仍比TD儿童更小、更短。手术使肌腹长度缩短，尽管骨骼生长，但1年后仍未改变。术后7周肌肉体积无显著变化，但在术后7周和1年之间显著增加。
与TD儿童相比，SDCP患儿的MG肌腹短小。我们的结果表明，VP手术后一年内腓肠肌体积可恢复。
本研究首次调查了手术对人体肌腹体积和长度的影响。该研究表明，VP手术不是导致伴有跖屈畸形的SDCP个体长期肌肉萎缩的因素。
