Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Republic of Korea.
Gait Posture. 2013 Apr;37(4):536-41. doi: 10.1016/j.gaitpost.2012.09.011. Epub 2012 Oct 5.
Distal hamstring lengthening (DHL) is a commonly performed procedure in flexed knee gait. However, the necessity of this procedure has been challenged due to the concerns on adverse effects in long-term follow-up. This retrospective study was undertaken to investigate the long-term outcome of single event multilevel surgery (SEMLS), including bilateral DHL, in ambulatory patients with cerebral palsy using 3D gait analysis. Twenty-nine ambulatory patients with spastic diplegic cerebral palsy who had undergone SEMLS including bilateral DHL were included. 3D gait analysis was performed preoperatively, 1 year postoperatively and over 10 years postoperatively. Preoperative temporal parameters, kinematics and GDI were compared with values obtained 1 and 10 year follow-up visits. The mean age of patients at time of first surgery was 8.3 years (range, 5.4-16.3 years), and mean time from first surgery to last 3D gait analysis was 11.8 years (range, 10.0-13.3 years). Mean pelvic tilt was not changed significantly after SEMLS including DHL. Mean knee flexion at initial contact decreased from 31.1° preoperatively to 26.0° at 1 year postoperatively (p=0.065), and then decreased significantly to 23.6° at 10 years postoperatively (p=0.038) versus the preoperative value. Mean GDI score significantly improved from 69.4 preoperatively to 77.9 at 1 year postoperatively (p=0.003) and continuously improved to 82.2 at 10 years postoperatively (p=0.017). Single event multilevel surgery including DHL provides a favorable outcome 10 years postoperatively in patients with spastic diplegic cerebral palsy.
单纯后侧肌腱延长术（DHL）是一种在膝关节弯曲步态中常用的手术。然而，由于对长期随访中不良影响的担忧，该手术的必要性受到了挑战。本回顾性研究旨在通过三维步态分析调查单阶段多平面手术（SEMLS），包括双侧 DHL，对痉挛性双瘫脑瘫患者的长期疗效。共纳入 29 例痉挛性双瘫脑瘫且接受 SEMLS 包括双侧 DHL 的可步行患者。术前、术后 1 年及术后 10 年以上进行三维步态分析。将术前的时间参数、运动学和 GDI 与术后 1 年和 10 年随访时的测量值进行比较。患者首次手术时的平均年龄为 8.3 岁（范围，5.4-16.3 岁），首次手术至最后一次三维步态分析的平均时间为 11.8 年（范围，10.0-13.3 年）。SEMLS 包括 DHL 后骨盆倾斜角无明显变化。初始接触时的平均膝关节屈曲度从术前的 31.1°减少到术后 1 年的 26.0°（p=0.065），然后在术后 10 年时明显减少到 23.6°（p=0.038），与术前相比。GDI 评分平均从术前的 69.4 显著提高到术后 1 年的 77.9（p=0.003），并持续提高到术后 10 年的 82.2（p=0.017）。痉挛性双瘫脑瘫患者接受 SEMLS 包括 DHL 术后 10 年可获得良好的效果。
