脑瘫的粗大运动功能分类系统与单期多节段手术：功能水平与随时间的干预之间存在关联吗？

The gross motor function classification system for cerebral palsy and single-event multilevel surgery: is there a relationship between level of function and intervention over time?

作者信息

Godwin Ellen M, Spero Charles R, Nof Leah, Rosenthal Rebecca R, Echternach John L

机构信息

Department of Orthopaedics and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.

出版信息

J Pediatr Orthop. 2009 Dec;29(8):910-5. doi: 10.1097/BPO.0b013e3181c0494f.

DOI:10.1097/BPO.0b013e3181c0494f

PMID:19934708

Abstract

BACKGROUND

The purpose of this study was to determine what effect, if any, an intervention such as Single-event multilevel orthopaedic surgery (SEMLS) might have on the relative stability of the gross motor function classification system (GMFCS) for cerebral palsy over a 5-year time period.

METHODS

Eighty-four children with spastic cerebral palsy who underwent SEMLS were included. The patients had an average of 5.45 procedures during surgery. Mean age at the time of surgery was 6 years. Two blinded physical therapists applied the GMFCS to functional descriptions extracted from outpatient clinical records. The patients were rated preoperatively, 1, 2, and 5 years postoperatively.

RESULTS

Interrater reliability was high, Kw=0.90. Friedman's nonparametric repeated measures analysis of variance was conducted comparing the GMFCS classification levels of the patients preoperatively and 1, 2, and 5 years after SEMLS. The patients as a group showed a significant change to a lower GMFCS classification postsurgery (P<0.001). Children classified at levels I and V of the GMFCS preoperatively showed lesser likelihood of changing functional levels postsurgery.

CONCLUSIONS

The results of this investigation support the concept that interventions, especifically SEMLS, can affect the stability of the GMFCS classification. The majority of children in this study showed changes in gross motor function classification as reflected by lower GMFCS scores after SEMLS intervention. We also found that changes were maintained over a period of 5 years. The results of this study suggest that certain interventions, such as SEMLS, might have an effect on the stability of the GMFCS and that effect may be level-dependent.

LEVEL OF EVIDENCE

Retrospective Study by Review of Medical Records. Level III in the Therapeutic Study investigating results of treatment category.

摘要

背景

本研究的目的是确定单事件多级骨科手术（SEMLS）等干预措施在5年时间内对脑瘫粗大运动功能分类系统（GMFCS）的相对稳定性是否有影响（若有影响，则确定其影响程度）。

方法

纳入84例接受SEMLS手术的痉挛型脑瘫患儿。这些患者在手术期间平均接受了5.45次手术。手术时的平均年龄为6岁。两名盲法物理治疗师将GMFCS应用于从门诊临床记录中提取的功能描述。对患者进行术前、术后1年、2年和5年的评分。

结果

评分者间信度较高，Kw = 0.90。采用Friedman非参数重复测量方差分析，比较患者术前以及SEMLS术后1年、2年和5年的GMFCS分类水平。作为一个整体，患者术后GMFCS分类有显著变化，降至更低水平（P < 0.001）。术前GMFCS分类为I级和V级的儿童术后功能水平改变的可能性较小。

结论

本研究结果支持这样一种观点，即干预措施，特别是SEMLS，可以影响GMFCS分类的稳定性。本研究中的大多数儿童在SEMLS干预后，粗大运动功能分类发生了变化，表现为GMFCS评分降低。我们还发现，这些变化在5年期间持续存在。本研究结果表明，某些干预措施，如SEMLS，可能会对GMFCS的稳定性产生影响，且这种影响可能与分类水平有关。