Sossai Roberto, Vavken Patrick, Brunner Reinald, Camathias Carlo, Graham H Kerr, Rutz Erich
Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland.
Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland; Orthopaedic Department, University Hospital Basle, Switzerland; Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Gait Posture. 2015 Feb;41(2):658-65. doi: 10.1016/j.gaitpost.2015.01.018. Epub 2015 Jan 27.
We evaluated the outcome of three different approaches to the management of flexed knee gait patients with spastic diplegia. The three surgical procedures were patellar tendon shortening (PTS), PTS combined with rotational osteotomies of the femur and/or tibia, and PTS combined with supracondylar extension osteotomy (SEO) of the distal femur. The primary outcome measure was gait kinematics. The knee gait variable score (GVS) and the gait profile score (GPS) were derived from gait kinematics. 24 patients (16 male and 8 female), mean age 16.1 years (SD 5.8 years), who had surgery between 2002 and 2008, were followed for a mean of 22 months. Knee extension during gait improved by a mean of 20° throughout the gait cycle, with an improvement in the knee GVS of 14° (p<0.001). The overall gait pattern improved with a mean decrease in GPS of 4.6°. Correction of patella alta was demonstrated by an improvement in the Koshino index from 1.34 pre-operatively to 1.10 post-operatively (p<0.001). Knee and gait kinematics, physical examination measures and Koshino Index improved in all three surgical groups, suggesting that a tailored approach to the correction of flexed knee gait in spastic diplegia is both feasible and appropriate.
Level III.
我们评估了三种不同方法治疗痉挛性双侧瘫屈膝步态患者的疗效。这三种手术方法分别是髌腱缩短术（PTS）、PTS联合股骨和/或胫骨旋转截骨术，以及PTS联合股骨远端髁上伸展截骨术（SEO）。主要结局指标是步态运动学。膝关节步态变量评分（GVS）和步态轮廓评分（GPS）源自步态运动学。对2002年至2008年间接受手术的24例患者（16例男性，8例女性）进行了随访，平均年龄16.1岁（标准差5.8岁），平均随访22个月。在整个步态周期中，步态期间膝关节伸展平均改善20°，膝关节GVS改善14°（p<0.001）。整体步态模式改善，GPS平均降低4.6°。通过Koshino指数从术前的1.34改善至术后的1.10（p<0.001），证明高位髌骨得到矫正。所有三个手术组的膝关节和步态运动学、体格检查指标以及Koshino指数均有改善，这表明针对痉挛性双侧瘫屈膝步态进行个性化矫正的方法是可行且恰当的。
III级。
