脑瘫患儿单纯马蹄足畸形行腓肠肌-比目鱼肌复合体延长术的疗效

Outcomes of gastrocnemius-soleus complex lengthening for isolated equinus contracture in children with cerebral palsy.

作者信息

Tylkowski Chester M, Horan Mike, Oeffinger Donna J

机构信息

Shriners Hospital for Children, and Department of Orthopedics, University of Kentucky, Chandler Medical Center, College of Medicine, Lexington, KY 40502, USA.

出版信息

J Pediatr Orthop. 2009 Oct-Nov;29(7):771-8. doi: 10.1097/BPO.0b013e3181b76a7c.

DOI:10.1097/BPO.0b013e3181b76a7c

PMID:20104161

Abstract

BACKGROUND

The goal of the gastrocnemius-soleus complex (GSC) lengthenings in children with cerebral palsy (CP) is to achieve a plantigrade foot and normalize kinematics during gait. The study purpose was to evaluate the results of GSC lengthening for isolated equinus contracture in individuals with CP. It was hypothesized that GSC lengthenings would normalize passive ankle range of motion, kinematic, kinetic, and temporal spatial parameters.

METHODS

Gait data from 15 able-bodied participants from the laboratory normal database and passive range of motion, kinematic, kinetic, and temporal spatial gait parameters, and oxygen cost were collected and analyzed for 27 individuals with CP (36 limbs) with isolated equinus contracture who received GSC lengthenings. Data were compared between preoperative and postoperative assessments.

RESULTS

Mean age at baseline was 11.4 years (+/-3.2 y). Mean time between surgery and postoperative gait analysis was 1.3 years (+/-0.3 y). Passive range of motion measurements were obtained. Kinematic and kinetic data for the hip, knee and ankle, and temporal spatial parameters were obtained from a representative gait trial preoperatively and postoperatively. Paired t tests (P<0.05) determined whether preoperative data differed from postoperative data or from able-bodied data. The passive range of motion at the ankle was improved and normalized postoperatively. Ankle kinematics normalized without compensatory changes occurring at the knee or hip kinematics. Ankle moments and powers become more normal but did not completely normalize. Kinematics and kinetics of the hip and knee were not adversely affected. No changes in the temporal spatial data or oxygen cost occurred postoperatively.

CONCLUSIONS

These data support the finding that with appropriate patient selection isolated GSC lengthening does not result in overcorrection.

LEVEL OF EVIDENCE

Retrospective comparative study; level 3.

摘要

背景

脑性瘫痪（CP）患儿的腓肠肌-比目鱼肌复合体（GSC）延长术的目标是实现足跖行并使步态中的运动学正常化。本研究目的是评估GSC延长术治疗CP患儿单纯马蹄足挛缩的效果。研究假设是GSC延长术将使被动踝关节活动范围、运动学、动力学及时间空间参数正常化。

方法

收集了来自实验室正常数据库的15名健康参与者的步态数据，以及27例接受GSC延长术治疗单纯马蹄足挛缩的CP患儿（36条肢体）的被动活动范围、运动学、动力学、时间空间步态参数和氧耗量，并进行分析。对术前和术后评估的数据进行比较。

结果

基线时的平均年龄为11.4岁（±3.2岁）。手术与术后步态分析之间的平均时间为1.3年（±0.3年）。获得了被动活动范围测量值。术前和术后从一次具有代表性的步态试验中获得了髋、膝和踝关节的运动学和动力学数据以及时间空间参数。配对t检验（P<0.05）确定术前数据与术后数据或与健康参与者数据是否存在差异。术后踝关节的被动活动范围得到改善并恢复正常。踝关节运动学恢复正常，膝关节或髋关节运动学未出现代偿性改变。踝关节力矩和功率变得更正常，但未完全恢复正常。髋和膝关节的运动学和动力学未受到不利影响。术后时间空间数据和氧耗量未发生变化。