Yu Stephanie, Rethlefsen Susan A, Wren Tishya A L, Kay Robert M
*California Children's Services, Children's Medical Services, Los Angeles County Department of Public Health, El Monte †Children's Orthopaedic Center, Children's Hospital Los Angeles ‡Department of Orthopaedic Surgery, Keck School of Medicine-University of Southern California, Los Angeles, CA.
J Pediatr Orthop. 2015 Apr-May;35(3):285-9. doi: 10.1097/BPO.0000000000000251.
Long-term studies of lower extremity orthopaedic surgery in children with cerebral palsy (CP) tend to focus on gait kinematics and kinetics, with little to no emphasis on gross motor ambulatory function. The current study was undertaken to examine the long-term impact of surgery on ambulatory function in patients with CP enrolled in a government-funded, outpatient therapy program.
Retrospective medical record review was conducted of 127 children with CP, Gross Motor Function Classification System (GMFCS) levels I to IV, followed up to 14 years after lower extremity orthopaedic surgery. Data were extracted from medical/operative records and routine physical therapy evaluations performed over the course of follow-up. Functional Mobility Scale (FMS) scores were assigned based on gross motor function information contained in each 6- to 12-month physical therapy evaluation. Data were compared statistically among GMFCS levels.
Average length of follow up was 11.8±4 years. Subjects underwent 0.61±0.43 surgical procedures per person-year in 0.16±0.09 operative sessions per person-year with no differences between GMFCS levels. Subjects at GMFCS level I improved significantly in community (P=0.02) but not household ambulation, reflecting the ceiling effect of the FMS. Subjects at GMFCS levels II to IV showed statistically significant improvements at all distances. Subjects at level III gained more in household than long-distance ambulation (P=0.002). Subjects functioning at GMFCS level II improved by 1 FMS level for household and school distances, and 2 FMS levels for community distances (P<0.02). Subjects at level IV exhibited small ambulatory gains at all distances (P<0.04).
Significant long-term improvement in functional ambulation is seen after surgery for children at all GMFCS levels. Children with more independence tend to make gains in long-distance ambulation, whereas those who use assistive devices tend to improve more in short-distance ambulation. This information may be useful to clinicians when counseling patients and their families regarding potential for ambulatory improvement after lower extremity orthopaedic surgery.
Level IV: case series.
对脑瘫（CP）患儿进行的下肢骨科手术长期研究往往侧重于步态运动学和动力学，很少或几乎不强调总体运动行走功能。本研究旨在探讨手术对参加政府资助的门诊治疗项目的CP患者行走功能的长期影响。
对127例GMFCS I至IV级的CP患儿进行回顾性病历审查，这些患儿在接受下肢骨科手术后随访了14年。数据从医疗/手术记录以及随访期间进行的常规物理治疗评估中提取。根据每6至12个月物理治疗评估中包含的总体运动功能信息分配功能活动量表（FMS）分数。对GMFCS各等级的数据进行统计学比较。
平均随访时间为11.8±4年。受试者每人每年接受0.61±0.43次手术，每人每年进行0.16±0.09次手术，GMFCS各等级之间无差异。GMFCS I级受试者在社区行走方面有显著改善（P = 0.02），但在家中行走方面无改善，这反映了FMS的天花板效应。GMFCS II至IV级受试者在所有距离上均有统计学显著改善。III级受试者在家中行走方面比远距离行走获得更多改善（P = 0.002）。GMFCS II级受试者在家中和学校距离的行走方面FMS水平提高1级，在社区距离的行走方面提高2级（P < 0.02）。IV级受试者在所有距离上的行走均有小幅改善（P < 0.04）。
对于所有GMFCS等级的儿童，手术后功能行走有显著的长期改善。独立性较强的儿童在远距离行走方面有所改善，而使用辅助设备的儿童在近距离行走方面改善更多。这些信息在临床医生为患者及其家属提供有关下肢骨科手术后行走改善潜力的咨询时可能会有所帮助。
IV级：病例系列。
