Department of Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Heidelberg, Germany.
Department of Trauma Surgery and Orthopaedics, University Medical Center Goettingen, Goettingen, Germany.
Res Dev Disabil. 2014 Jun;35(6):1357-63. doi: 10.1016/j.ridd.2014.03.032. Epub 2014 Apr 3.
Primary genu recurvatum (GR) is less investigated and data presenting the prevalence among patients with bilateral spastic cerebral palsy (BSCP) is lacking in the literature. Equinus is mentioned as one of the main underlying factors in GR, but its influence on the severity and onset type of GR is mainly unanswered, yet. Hence, the purpose of this retrospective study was to assess the prevalence of GR in a large sample size in children with BSCP and to investigate sagittal plane kinematics to evaluate the influence of equinus on different GR types using data of three-dimensional gait analysis. GR was defined as a knee hyperextension of more than one standard deviation of an age matched control group during stance phase in either one or both of the limbs. Primary GR was defined as a GR without having previous surgery regarding the lower extremity, no selective dorsal rhizotomy and/or interventions like botulinum toxin injection, shock wave therapy or serial casting during the last 6 months in the patient history. In a retrospective study 463 patients with BSCP (GMFCS Level I-III) received three-dimensional gait analysis and were scanned for the presence of primary GR. Finally, 37 patients (23 males, 14 females) matched the determined inclusion criteria and were therefore included for further analysis in this study. Out of those patients seven walked with orthoses or a walker and were excluded from further statistical comparison: Kinematics of the lower limbs were compared between patients having severe (knee hyperextension>15°) and moderate (knee hyperextension 5-15°) GR and between patients showing an early (first half of stance phase) and a late (second half of stance phase) GR. Primary GR was present in 37 patients/52 limbs (prevalence 8.0/5.6%). Severe GR was associated with a decreased ankle dorsiflexion compared with moderate GR. Early GR showed an increased knee hyperextension compared to late GR. In conclusion GR is less frequent compared with crouch or stiff gait. Our findings support the importance of equinus as a major underlying factor in primary GR. In this context the influence of equinus seems to be more important in early GR.
原发性膝反屈（GR）研究较少，文献中缺乏双侧痉挛性脑瘫（BSCP）患者的患病率数据。马蹄内翻是 GR 的主要潜在因素之一，但它对 GR 的严重程度和发病类型的影响主要没有得到解答。因此，本回顾性研究的目的是评估大量 BSCP 患儿中 GR 的患病率，并通过三维步态分析评估马蹄内翻对不同 GR 类型的影响。在站立相期间，GR 定义为肢体单侧或双侧的膝关节过伸超过年龄匹配对照组的一个标准差。原发性 GR 定义为在过去 6 个月内，患者病史中没有下肢手术、选择性脊神经后根切断术和/或肉毒毒素注射、冲击波治疗或连续石膏固定等治疗史的 GR。在一项回顾性研究中，463 例 BSCP 患儿（GMFCS Ⅰ-Ⅲ级）接受了三维步态分析，并对原发性 GR 的存在进行了扫描。最后，37 例（男 23 例，女 14 例）符合确定的纳入标准，因此被纳入本研究的进一步分析。在这些患者中，有 7 例使用矫形器或助行器行走，被排除在进一步的统计比较之外：将膝关节过伸严重（>15°）和中度（5-15°）的患者以及在站立相早期（前半段）和晚期（后半段）的患者的下肢运动学进行比较。37 例患者中有 52 例（8.0/5.6%）存在原发性 GR。与中度 GR 相比，严重 GR 患者的踝关节背屈减少。与晚期 GR 相比，早期 GR 的膝关节过伸增加。总之，与蹲伏或僵硬步态相比，GR 的发生率较低。我们的发现支持马蹄内翻作为原发性 GR 的主要潜在因素的重要性。在这种情况下，马蹄内翻对早期 GR 的影响似乎更为重要。
