Braatz F, Poljuchow J, Klotz M C, Heitzmann D W W, Wolf S I, Dreher T
Klinik für Unfallchirurgie und Orthopädie - Abteilung Orthopädie, Universitätsmedizin Göttingen.
Klinik für Gynäkologie und Geburtshilfe, Klinik Sankt Elisabeth in Heidelberg.
Z Orthop Unfall. 2015 Dec;153(6):636-42. doi: 10.1055/s-0035-1557934. Epub 2015 Oct 15.
Patients with spastic cerebral palsy GMFCS I-III often develop gait dysfunctions. One of the most prevalent gait dysfunctions is the intoeing gait. Femoral derotation osteotomy is the common treatment for internal rotation gait in cerebral palsy. We now present 3D-gait analysis data of the hip rotation in gait before and after femoral derotation osteotomy. We analysed the influence of the age at the index operation on the risk of recurrence and the surgical technique.
We included 48 patients treated with femoral derotation osteotomy during a single event of multi-level surgery. Mean hip rotation in standing was measured before and after femoral derotation osteotomy (FDO). The patients were divided into two groups of different age and in a second analysis into two groups with the osteotomy in different locations, either inter-trochanteric (DO proximal) or supracondylar (DO distal).
Age at FDO and surgical technique had no influence on the results. However, the variance of the results was very high. Differences were found in the walking speed between the DO proximal and DO distal groups. The walking speed in the group of distal femoral osteotomy was higher. This difference was not significant, but there was a trend to proximal osteotomy in slower walkers. Significant improvements in IRG after FDO were found in our investigation. Our results indicate that FDO as a part of single-event multilevel surgery SEMLS provides a satisfactory mean overall correction of IRG. The results were independent of the age at the index operation and the location of the osteotomy.
痉挛型脑性瘫痪GMFCS I - III级的患者常出现步态功能障碍。最常见的步态功能障碍之一是内收步态。股骨旋转截骨术是治疗脑瘫内旋步态的常用方法。我们现在展示股骨旋转截骨术前后步态中髋关节旋转的三维步态分析数据。我们分析了初次手术时的年龄对复发风险的影响以及手术技术。
我们纳入了48例在单次多级手术中接受股骨旋转截骨术治疗的患者。在股骨旋转截骨术（FDO）前后测量站立时的平均髋关节旋转度。患者被分为两组不同年龄组，在第二项分析中，根据截骨位置分为两组，即转子间（近端DO）或髁上（远端DO）。
FDO时的年龄和手术技术对结果没有影响。然而，结果的方差非常高。在近端DO组和远端DO组之间发现了步行速度的差异。远端股骨截骨术组的步行速度更高。这种差异不显著，但在步行较慢的患者中有近端截骨的趋势。在我们的研究中发现FDO后IRG有显著改善。我们的结果表明，FDO作为单次多级手术（SEMLS）的一部分，对IRG提供了令人满意的平均总体矫正。结果与初次手术时的年龄和截骨位置无关。
