Van Gestel Leen, Molenaers Guy, Huenaerts Catherine, Seyler Jos, Desloovere Kaat
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium.
Dev Med Child Neurol. 2008 Jan;50(1):63-7. doi: 10.1111/j.1469-8749.2007.02014.x.
Several positive influences of orthoses on gait in children with cerebral palsy have been documented, as well as some detrimental effects. Most importantly, push-off is decreased in orthoses, compromising a physiological third ankle rocker. The aim of this study was to evaluate the effect of three types of orthosis on gait in a homogeneous group of children. All orthoses aimed at improving push-off and normalizing the pathological plantarflexion-knee extension couple. Thirty-seven children (22 females, 15 males) with hemiplegia, aged 4 to 10 years (30 Gross Motor Function Classification System [GMFCS] Level I, six GMFCS Level II), walked barefoot and with orthoses being either Orteams (orthoses with the dorsal part containing 11 sleeves), posterior leafsprings (PLS), or Dual Carbon Fibre Spring ankle foot orthosis (AFOs; CFO: carbon fibre at the dorsal part of the orthosis). All orthoses were expected to prevent plantarflexion and allow dorsiflexion, thus improving first, second, and third rocker. The orthoses were compared through objective gait analysis, including 3D kinematics and kinetics. All orthoses successfully improved the gait pattern and only small differences were noted between the configurations of the different orthoses. The CFO, however, allowed a more physiological third ankle rocker compared with the Orteam/PLS. Although the PLS ensured the highest correction at the ankle around initial contact, the CFO created a significantly higher maximal hip flexion moment in stance. In general, the results of this study indicated a substantial functional flexibility of the CFO.
已有文献记载了矫形器对脑瘫儿童步态的几种积极影响以及一些不利影响。最重要的是，矫形器会降低蹬离动作，影响生理性的第三个踝关节摆动期。本研究的目的是评估三种类型的矫形器对一组同质儿童步态的影响。所有矫形器的目的都是改善蹬离动作并使病理性跖屈 - 膝伸展组合正常化。37名偏瘫儿童（22名女性，15名男性），年龄4至10岁（30名粗大运动功能分级系统[GMFCS] I级，6名GMFCS II级），分别在赤足以及佩戴Orteams（背侧部分有11个套筒的矫形器）、后叶弹簧（PLS）或双碳纤维弹簧踝足矫形器（AFOs；CFO：矫形器背侧部分为碳纤维）的情况下行走。所有矫形器都预期能防止跖屈并允许背屈，从而改善第一、第二和第三个摆动期。通过客观步态分析对这些矫形器进行比较，包括三维运动学和动力学分析。所有矫形器都成功改善了步态模式，不同矫形器配置之间仅发现了微小差异。然而，与Orteam/PLS相比，CFO能使第三个踝关节摆动期更接近生理状态。虽然PLS在初始接触时能确保踝关节的最大矫正，但CFO在站立期产生的最大髋关节屈曲力矩明显更高。总体而言，本研究结果表明CFO具有很大的功能灵活性。
