Rha Dong-Wook, Cahill-Rowley Katelyn, Young Jeffrey, Torburn Leslie, Stephenson Katherine, Rose Jessica
Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Motion & Gait Analysis Laboratory, Lucile Packard Children's Hospital, Palo Alto, CA; Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Motion & Gait Analysis Laboratory, Lucile Packard Children's Hospital, Palo Alto, CA; Department of Bioengineering, Stanford University, Stanford, CA.
Arch Phys Med Rehabil. 2015 Mar;96(3):511-7. doi: 10.1016/j.apmr.2014.09.039. Epub 2014 Oct 31.
To identify clinical and biomechanical parameters that influence swing-phase knee flexion and contribute to stiff-knee gait in individuals with spastic cerebral palsy (CP) and flexed-knee gait.
Retrospective analysis of clinical data and gait kinematics collected from 2010 to 2013.
Motion and gait analysis laboratory at a children's hospital.
Individuals with spastic CP (N=34; 20 boys, 14 girls; mean age ± SD, 10.1±4.1y [range, 5-20y]; Gross Motor Function Classification System I-III) who walked with flexed-knee gait ≥20° at initial contact and had no prior surgery were included; the more-involved limb was analyzed.
Not applicable.
The magnitude and timing of peak knee flexion (PKF) during swing were analyzed with respect to clinical data, including passive range of motion and Selective Control Assessment of the Lower Extremity, and biomechanical data, including joint kinematics and hamstring, rectus femoris, and gastrocnemius muscle-tendon length during gait.
Data from participants demonstrated that achieving a higher magnitude of PKF during swing correlated with a higher maximum knee flexion velocity in swing (ρ=.582, P<0.001) and a longer maximum length of the rectus femoris (ρ=.491, P=.003). In contrast, attaining earlier timing of PKF during swing correlated with a higher knee flexion velocity at toe-off (ρ=-.576, P<.001), a longer maximum length of the gastrocnemius (ρ=-.355, P=.039), and a greater peak knee extension during single-limb support phase (ρ=-.354, P=.040).
Results indicate that the magnitude and timing of PKF during swing were independent, and their biomechanical correlates differed, suggesting important treatment implications for both stiff-knee and flexed-knee gait.
确定影响摆动期膝关节屈曲并导致痉挛性脑瘫（CP）患者出现膝关节僵硬步态和屈膝步态的临床及生物力学参数。
对2010年至2013年收集的临床数据和步态运动学进行回顾性分析。
一家儿童医院的运动与步态分析实验室。
纳入了痉挛性CP患者（N = 34；20名男孩，14名女孩；平均年龄±标准差，10.1±4.1岁[范围，5 - 20岁]；粗大运动功能分类系统I - III级），这些患者在初始接触时屈膝步态≥20°且未接受过先前手术；分析的是受累更严重的肢体。
不适用。
针对临床数据（包括被动活动范围和下肢选择性控制评估）以及生物力学数据（包括步态期间的关节运动学和腘绳肌、股直肌及腓肠肌肌腱长度），分析摆动期峰值膝关节屈曲（PKF）的幅度和时间。
参与者的数据表明，摆动期达到更高幅度的PKF与摆动期更高的最大膝关节屈曲速度相关（ρ = 0.582，P < 0.001）以及股直肌更长的最大长度相关（ρ = 0.491，P = 0.003）。相比之下，摆动期PKF时间更早与离地时更高的膝关节屈曲速度相关（ρ = -0.576，P < 0.001）、腓肠肌更长的最大长度相关（ρ = -0.355，P = 0.039）以及单腿支撑期更大的峰值膝关节伸展相关（ρ = -0.354，P = 0.040）。
结果表明，摆动期PKF的幅度和时间是独立的，且它们的生物力学相关性不同，这表明对于膝关节僵硬步态和屈膝步态都具有重要的治疗意义。
