Orthopaedic Department, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
J Bone Joint Surg Am. 2013 May 15;95(10):931-8. doi: 10.2106/JBJS.K.01542.
In children with spastic diplegia, surgery for ankle equinus contracture is associated with a high prevalence of both overcorrection, which may result in a calcaneal deformity and crouch gait, and recurrent equinus contracture, which may require revision surgery. We sought to determine if conservative surgery for equinus gait, in the context of multilevel surgery, could result in the avoidance of overcorrection and crouch gait as well as an acceptable rate of recurrent equinus contracture at the time of medium-term follow-up.
This was a retrospective, consecutive cohort study of children with spastic diplegia who had had surgery for equinus gait between 1996 and 2006. All children had distal gastrocnemius recession or differential gastrocnemius-soleus complex lengthening, on one or both sides, as part of single-event multilevel surgery. The primary outcome measures were the Gait Variable Scores (GVS) and Gait Profile Score (GPS) at two time points after surgery.
Forty children with spastic diplegia, Gross Motor Function Classification System (GMFCS) level II or III, were included in this study. There were twenty-five boys and fifteen girls. The mean age was ten years at the time of surgery and seventeen years at the time of final follow-up. The mean postoperative follow-up period was 7.5 years. The mean ankle GVS improved from 18.5° before surgery to 8.7° at the time of short-term follow-up (p < 0.005) and 7.8° at the time of medium-term follow-up. The equinus gait was successfully corrected in the majority of children, with a low rate of overcorrection (2.5%) and a high rate of recurrent equinus (35%), as determined by sagittal ankle kinematics. Mild recurrent equinus was usually well tolerated and conferred some advantages, including contributing to strong coupling at the knee and independence from using an ankle-foot orthosis.
Surgical treatment for equinus gait in children with spastic diplegia was successful, at a mean of seven years, in the majority of cases when combined with multilevel surgery, orthoses, and rehabilitation. No patient developed crouch gait, and the rate of revision surgery for recurrent equinus was 12.5%.
在痉挛性双瘫患儿中，踝关节马蹄内翻挛缩的手术治疗与过度矫正的高发生率相关，这可能导致跟骨畸形和垂足步态，且易复发马蹄内翻挛缩，需要再次手术修正。我们旨在探讨在多水平手术背景下，针对马蹄内翻步态进行的保守性手术治疗是否可以避免过度矫正和垂足步态，并在中期随访时获得可接受的复发马蹄内翻挛缩率。
这是一项回顾性连续队列研究，纳入了 1996 年至 2006 年间接受马蹄内翻步态手术治疗的痉挛性双瘫患儿。所有患儿均接受了单侧或双侧腓肠肌延长术或腓肠肌-比目鱼肌复合体差异化延长术，作为单阶段多水平手术的一部分。主要结局测量指标为术后两个时间点的步态变量评分（Gait Variable Scores，GVS）和步态轮廓评分（Gait Profile Score，GPS）。
本研究共纳入 40 例痉挛性双瘫患儿，Gross Motor Function Classification System（GMFCS）分级 II 或 III 级，男 25 例，女 15 例。手术时的平均年龄为 10 岁，末次随访时的平均年龄为 17 岁。术后平均随访时间为 7.5 年。术后踝关节 GVS 从术前的 18.5°改善至短期随访时的 8.7°（p<0.005）和中期随访时的 7.8°。大多数患儿的马蹄内翻步态得到成功矫正，仅 2.5%的患儿出现过度矫正，35%的患儿出现马蹄内翻复发，这通过矢状面踝关节运动学确定。轻度马蹄内翻复发通常可被良好耐受，并具有一定优势，包括有助于膝关节的强力耦合和避免使用踝足矫形器。
在痉挛性双瘫患儿中，当与多水平手术、矫形器和康复相结合时，针对马蹄内翻步态进行的手术治疗在平均 7 年时多数是成功的。没有患儿出现垂足步态，且复发马蹄内翻挛缩的再次手术率为 12.5%。
