Section for Child Neurology, Norway.
Acta Orthop. 2010 Apr;81(2):245-9. doi: 10.3109/17453671003587135.
Rotational osteotomies are usually necessary to correct pronounced rotational deformities in ambulant children with cerebral palsy. The effects of soft tissue surgery on such deformities are unclear. In this retrospective study, we determined whether multilevel soft tissue surgery, performed to correct deformities in the sagittal plane, would also have an effect on rotational parameters.
We examined 28 ambulant children with spastic diplegia with an average age of 12 (7-19) years. They underwent multilevel soft tissue surgery (with 6 surgical procedures per child on average). 3-dimensional gait analysis was performed preoperatively and at an average follow-up of 1-2 years. The indications for surgery were abnormalities in the sagittal plane. Gait analysis data from healthy children were used in defining normal ranges of kinematic variables. For assessment of changes in the transverse plane, the angles of foot progression, hip rotation, and pelvic rotation were studied.
The transverse plane kinematic results showed no statistically significant postoperative changes when the preoperative parameters were within the normal range (within 2 SD of the mean of the normal material). In limbs where the preoperative values were abnormal (more than 2 SD above the normal mean), there was a mean reduction in internal foot progression of 12 degrees (p = 0.01) and a mean reduction in external pelvic rotation of 6 degrees (p = 0.02). The effect was more pronounced in children under 12 years of age. Internal hip rotation was not significantly reduced.
When the preoperative rotational parameters were abnormal, multilevel soft tissue surgery resulted in improved transverse plane kinematics. This could be of importance in preoperative decision making, especially when there is doubt as to whether to include rotational osteotomies in multilevel operations in younger children.
对于能够行走的脑瘫患儿，如果存在明显的旋转畸形，通常需要进行旋转截骨术来矫正。软组织手术对此类畸形的影响尚不清楚。在本回顾性研究中，我们旨在确定多平面软组织手术（平均每例患儿进行 6 个手术）是否也会对旋转参数产生影响，这些手术用于矫正矢状面的畸形。
我们检查了 28 名平均年龄为 12 岁（7-19 岁）的痉挛性双瘫可步行患儿。他们接受了多平面软组织手术。术前和平均 1-2 年的随访时均进行了三维步态分析。手术指征为矢状面异常。正常儿童的步态分析数据用于定义运动学变量的正常范围。为了评估横向平面的变化，研究了足进路角度、髋关节旋转和骨盆旋转角度。
当术前参数在正常范围内（在正常材料平均值的 2 个标准差内）时，横向平面运动学结果无统计学意义的术后变化。在术前值异常的肢体（超过正常平均值 2 个标准差以上）中，内足进路角度平均减少 12 度（p = 0.01），外骨盆旋转角度平均减少 6 度（p = 0.02）。12 岁以下儿童的效果更为明显。髋关节内旋无明显减少。
当术前旋转参数异常时，多平面软组织手术可改善横向平面运动学。这在术前决策中可能很重要，尤其是在是否需要在年龄较小的患儿的多平面手术中包括旋转截骨术存在疑问时。
