股直肌转移术改善痉挛性脑瘫儿童僵硬膝关节步态。
Rectus femoris transfer improves stiff knee gait in children with spastic cerebral palsy.
机构信息
Department of Orthopaedics, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
出版信息
Clin Orthop Relat Res. 2012 May;470(5):1303-11. doi: 10.1007/s11999-011-2215-1.
BACKGROUND
Stiff knee gait is common among children with ambulatory cerebral palsy (CP). When surgery is indicated, rectus femoris transfer as a primary treatment enhances knee range of motion, reduces time to peak knee flexion, increases peak knee flexion, and reduces toe drag.
QUESTIONS/PURPOSES: We determined whether (1) distal rectus femoris transfer improved knee range of motion, time to peak knee flexion, peak knee flexion, and toe drag in children with CP diagnosed with stiff knee gait; and (2) patients in some subgroups (eg, those with relatively high knee range of motion compared with those with low knee range of motion before rectus femoris transfer) had greater improvement in these parameters.
METHODS
We retrospectively reviewed gait data from 56 patients (99 limbs) preoperatively, short-term, and long-term. Subgroup analyses were performed to determine whether patients with high knee range of motion relative to those with low or moderate knee range of motion improved differentially after rectus femoris transfer. The minimum followup was 7 years (mean ± SD, 10 ± 2 years; range, 7-13 years).
RESULTS
The mean peak knee flexion increased from baseline to short-term and to long-term followup. Patients with low peak knee flexion had the greatest improvement of peak knee flexion after rectus femoris transfer relative to the moderate and high peak knee flexion subgroups. Similarly, the greatest improvement after rectus femoris transfer for knee range of motion occurred in the low knee range of motion subgroup relative to moderate and high subgroups. Rectus femoris transfer improved mean time to peak knee flexion at short-term and long-term followup compared with baseline. Likewise, there was a decrease in toe drag at short- and long-term after rectus femoris transfer.
CONCLUSION
Distal rectus femoris transfer selectively improved peak knee flexion, toe drag, and reduced time to peak knee flexion in ambulatory children with CP with stiff knee gait.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See guidelines for authors for a complete description of levels of evidence.
背景
步行型脑瘫患儿常出现膝关节僵硬步态。当需要手术时，作为初始治疗的股直肌转位术可以增加膝关节活动度，缩短达到最大屈膝角度的时间，增加最大屈膝角度，并减少足拖地。
问题/目的：我们旨在确定（1）对于诊断为膝关节僵硬步态的脑瘫患儿，远端股直肌转位术是否改善了膝关节活动度、达到最大屈膝角度的时间、最大屈膝角度和足拖地；（2）某些亚组患者（例如，与股直肌转位术前相比，膝关节活动度相对较高的患者）在这些参数上是否有更大的改善。
方法
我们回顾性分析了 56 例（99 侧）患儿术前、短期和长期的步态数据。进行亚组分析，以确定膝关节活动度较高的患者与膝关节活动度较低或中等的患者相比，在股直肌转位术后是否有不同程度的改善。最小随访时间为 7 年（平均 ± 标准差，10 ± 2 年；范围，7-13 年）。
结果
平均最大屈膝角度从基线到短期和长期随访都有所增加。与中、高度最大屈膝角度亚组相比，低最大屈膝角度的患者在股直肌转位术后最大屈膝角度的改善程度最大。同样，在低膝关节活动度亚组中，股直肌转位术后膝关节活动度的改善程度最大，而在中、高度膝关节活动度亚组中则最小。与基线相比，股直肌转位术在短期和长期随访时均缩短了达到最大屈膝角度的时间。同样，股直肌转位术后在短期和长期随访时足拖地的情况也有所减少。
结论
在有膝关节僵硬步态的脑瘫患儿中，远端股直肌转位术选择性地改善了最大屈膝角度、足拖地和达到最大屈膝角度的时间。
证据等级
IV 级，治疗性研究。欲了解完整的证据等级描述，请参见作者指南。
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