Shore Benjamin J, White Nathan, Kerr Graham H
J Child Orthop. 2010 Aug;4(4):277-90. doi: 10.1007/s11832-010-0268-4. Epub 2010 Jul 1.
Equinus is the most common deformity in cerebral palsy. However, despite the large volume of published studies, there are poor levels of evidence to support surgical intervention. This study was undertaken to examine the current evidence base for the surgical management of equinus deformity in cerebral palsy.
A systematic review of the literature using "equinus deformity", "cerebral palsy" and "orthopaedic surgery" generated 49 articles. After applying inclusion and exclusion criteria, 35 articles remained. The Oxford Centre for Evidence-Based Medicine (CEBM) levels of evidence and the Methodological Index for Non-Randomized Studies (MINORS) were used to grade the articles.
Studies ranged in sample size from 9 to 156 subjects, with an average of 38 subjects. The mean age of subjects at index surgery ranged from 5 to 19 years. Nineteen studies used instrumented gait analysis, with an average follow-up of 2.8 years. Seven studies reported that a younger age at index surgery was associated with an increased risk of recurrent equinus. The average rate of calcaneus in hemiplegic children was 1% and it was 15% in those with spastic diplegia. Most studies were level 4 quality of evidence, leading to, at best, only grade C recommendation.
Cerebral palsy subtype (hemiplegia versus diplegia) and age at index surgery were the two most important variables for determining the outcome of surgery for equinus deformity in cerebral palsy. Despite the great emphasis on differences in surgical procedures, there was less evidence to support the type of operation in relation to outcome.
马蹄足是脑瘫中最常见的畸形。然而，尽管已发表的研究数量众多，但支持手术干预的证据水平较低。本研究旨在探讨目前脑瘫马蹄足畸形手术治疗的证据基础。
使用“马蹄足畸形”“脑瘫”和“矫形外科手术”对文献进行系统回顾，共筛选出49篇文章。应用纳入和排除标准后，剩余35篇文章。采用牛津循证医学中心（CEBM）的证据水平和非随机研究方法学指数（MINORS）对文章进行分级。
研究样本量从9至156名受试者不等，平均为38名。初次手术时受试者的平均年龄在5至19岁之间。19项研究采用了仪器化步态分析，平均随访2.8年。7项研究报告称，初次手术时年龄较小与马蹄足复发风险增加有关。偏瘫儿童跟骨的平均发生率为1%，痉挛性双瘫儿童为15%。大多数研究的证据质量为4级，至多只能给出C级推荐。
脑瘫亚型（偏瘫与双瘫）和初次手术时的年龄是决定脑瘫马蹄足畸形手术结局的两个最重要变量。尽管人们非常强调手术方法的差异，但关于手术类型与结局关系的证据较少。
