股直肌转移术用于治疗脑瘫痉挛性膝步态患者。

Rectus femoris transfer in cerebral palsy patients with stiff knee gait.

作者信息

Lee Seung Yeol, Kwon Soon-Sun, Chung Chin Youb, Lee Kyoung Min, Choi Young, Kim Tae Gyun, Shin Woo Cheol, Choi In Ho, Cho Tae-Joon, Yoo Won Joon, Park Moon Seok

机构信息

Department of Orthopaedic Surgery, Mongji Hospital, Kyungki, Republic of Korea.

Biomedical Research Institute, Seoul National University Bundang Hospital, Kyungki, Republic of Korea.

出版信息

Gait Posture. 2014;40(1):76-81. doi: 10.1016/j.gaitpost.2014.02.013. Epub 2014 Mar 2.

DOI:10.1016/j.gaitpost.2014.02.013

PMID:24656919

Abstract

BACKGROUND

Although several studies have reported on the outcomes of rectus femoris transfer (RFT), few have investigated the multiple factors that could affect the results. Therefore, we evaluated the outcomes of RFT and analyzed factors that influence improvement and annual change in knee motion after surgery in patients with cerebral palsy (CP).

METHODS

We reviewed ambulatory patients with CP who were followed up after they had undergone RFT as part of a single-event multilevel surgery (SEMLS) and who had undergone preoperative and postoperative three-dimensional (3D) gait analysis between January 1995 and December 2012. Relevant kinematic values, including peak knee flexion, knee range of motion, and timing of peak knee flexion in the swing phase and gait deviation index (GDI) score, were the outcome measures. Improvements in rate of angle and GDI score were adjusted by multiple factors such as sex, Gross Motor Function Classification System (GMFCS) level, anatomic type of CP, and concomitant surgeries as the fixed effects, and follow-up duration, laterality, and each subject as the random effects, all of which was performed using a linear mixed model.

RESULTS

A total of 290 patients (487 limbs) and 612 3D gait analysis (2-4 per patient) results were finally included in this study. At 2 years after RFT, estimated mean peak knee flexion (1.2°, p=0.005), estimated mean knee range of motion (10.7°, p<0.001), and estimated mean GDI score (7.3, p<0.001) increased significantly. Peak knee flexion in the swing phase occurred 5.4% earlier after surgery compared with that at baseline (p<0.001). In serial postoperative gait analyses, peak knee flexion in the swing phase occurred 0.8% earlier per year in patients with GMFCS level I or II (p=0.021).

CONCLUSIONS

RFT as part of a SEMLS was effective in treating stiff knee gait. In serial postoperative gait analyses, patients with GMFCS level I or II showed better prognosis than those with level III with regard to timing of peak knee flexion in the swing phase.

LEVEL OF EVIDENCE

Prognostic level IV.

摘要

背景

尽管多项研究报告了股直肌转移术（RFT）的结果，但很少有研究调查可能影响结果的多种因素。因此，我们评估了RFT的结果，并分析了影响脑瘫（CP）患者术后膝关节活动改善及年度变化的因素。

方法

我们回顾了接受RFT作为单阶段多水平手术（SEMLS）一部分的门诊CP患者，这些患者在1995年1月至2012年12月期间接受了术前和术后三维（3D）步态分析。相关运动学值，包括膝关节最大屈曲角度、膝关节活动范围、摆动期膝关节最大屈曲时间以及步态偏差指数（GDI）评分，作为观察指标。角度变化率和GDI评分的改善情况通过多种因素进行校正，如性别、粗大运动功能分级系统（GMFCS）水平、CP的解剖类型以及同期手术作为固定效应，随访时间、患侧以及每个受试者作为随机效应，所有这些均使用线性混合模型进行分析。

结果

本研究最终纳入了290例患者（487条肢体）和612次3D步态分析结果（每位患者2 - 4次）。RFT术后2年，估计平均膝关节最大屈曲角度（1.2°，p = 0.005）、估计平均膝关节活动范围（10.7°，p < 0.001）和估计平均GDI评分（7.3，p < 0.001）均显著增加。与基线相比，术后摆动期膝关节最大屈曲时间提前了5.4%（p < 0.001）。在术后连续步态分析中，GMFCS I或II级患者摆动期膝关节最大屈曲时间每年提前0.8%（p = 0.021）。