Murdoch Childrens Research Institute, The Royal Children's Hospital, Victoria, Australia.
Clin Orthop Relat Res. 2013 Mar;471(3):1028-38. doi: 10.1007/s11999-012-2766-9. Epub 2013 Jan 3.
Gait and function may deteriorate with time in patients with spastic diplegia. Single-event multilevel surgery often is performed to either improve gait or prevent deterioration. However it is unclear whether the presumed gait improvements are durable.
QUESTIONS/PURPOSES: We therefore determined whether (1) single-event multilevel surgery improves gait in patients with spastic diplegia and (2) whether the improved function is durable.
We retrospectively reviewed the data of 14 patients with spastic diplegia. At the time of surgery, one patient had gross motor Level I function, 10 patients had Level II function, and three patients had Level III function. There were four females and 10 males with a mean age of 13 years (range, 7-18 years). The mean number of orthopaedic procedures per single-event multilevel surgery session was 7.4 ± 2.8 (median, 6.5; range, 4-15). We used instrumented gait analysis to determine joint ROM, movement analysis profiles, and the gait profile score. The minimum followup was 1 year (mean, 2 years; range, 1-3 years).
At last followup, movement analysis profiles for knee flexion, for ankle dorsiflexion, and for foot progression improved as did the gait profile score. Additional surgery after the index procedure was performed in nine of the 14 patients because of relapse of the original or new gait problems. Major surgical adverse events occurred in one of the 14 patients.
Severe gait dysfunction in patients with spastic diplegia can be improved short-term in one operative session by single-event multilevel surgery, but to preserve the early improvements many patients require additional surgery. It is unknown whether the improvements will last for decades.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
痉挛性双瘫患者的步态和功能可能会随时间恶化。通常会进行单事件多水平手术，以改善步态或防止恶化。但是，目前尚不清楚假定的步态改善是否持久。
问题/目的：因此，我们确定了（1）单事件多水平手术是否能改善痉挛性双瘫患者的步态，以及（2）改善后的功能是否持久。
我们回顾性地分析了 14 例痉挛性双瘫患者的数据。手术时，1 例患者的粗大运动功能为 1 级，10 例为 2 级，3 例为 3 级。有 4 名女性和 10 名男性，平均年龄 13 岁（范围，7-18 岁）。单次多水平手术的平均矫形手术次数为 7.4 ± 2.8（中位数，6.5；范围，4-15）。我们使用仪器步态分析来确定关节 ROM、运动分析谱和步态分析谱评分。最低随访时间为 1 年（平均 2 年；范围，1-3 年）。
末次随访时，膝关节屈曲、踝关节背屈和足推进运动分析谱以及步态分析谱评分均有改善。14 例患者中有 9 例在索引手术后因原有或新的步态问题复发而进行了额外手术。14 例患者中有 1 例发生了重大手术不良事件。
在单次手术中，痉挛性双瘫患者严重的步态功能障碍可以在短期内得到改善，但为了保持早期改善，许多患者需要进行额外的手术。目前尚不清楚这些改善是否能持续数十年。
IV 级，治疗研究。完整的证据水平描述请参见作者指南。
