Klotz Matthias C M, Heitzmann Daniel W W, Wolf Sebastian I, Niklasch Mirjam, Maier Michael W, Dreher Thomas
Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
Res Dev Disabil. 2016 Jan;48:186-92. doi: 10.1016/j.ridd.2015.09.017. Epub 2015 Nov 19.
Recent reports have shown that timing of genu recurvatum (GR) might be caused by different underlying factors and that equinus leads to GR especially during early stance. The purpose of this study was to investigate the reduction of GR after surgical correction of equinus in children with bilateral spastic cerebral palsy and whether the children with early and late type GR show differences in reduction of knee hyperextension after a surgery. In 24 limbs (mean age 10.3 years, GMFCS I-III) showing equinus and GR the kinematics of the knee and ankle as well as the kinetics of the knee were evaluated before and one year (mean follow up period: 12.8 months) after surgical correction of equinus. The study was approved by the local ethical committee. Limbs with early type GR showed a reduction by 11.1° (p<0.001) and those with late type GR by 6.0° (p<0.049) in GR after surgery. Before surgery limbs with early type GR showed increased external extending moments, which decreased significantly after surgery. In contrast limbs with late GR did not show a significant reduction of those moments. The findings of this study underline the influence of equinus on early GR as an underlying factor. As equinus is attributed to early knee hyperextension and proximal factors are more important as underlying factors in late type GR, a classification into early and late onset GR is useful to identify underlying factors and to choose adequate treatment.
近期报告显示，膝反屈（GR）的发生时间可能由不同的潜在因素引起，且马蹄足尤其在站立初期会导致膝反屈。本研究的目的是调查双侧痉挛性脑瘫患儿马蹄足手术矫正后膝反屈的减轻情况，以及早发型和晚发型GR患儿在手术后膝过伸减轻方面是否存在差异。对24条肢体（平均年龄10.3岁，GMFCS I - III级）进行研究，这些肢体存在马蹄足和膝反屈，在马蹄足手术矫正前及术后一年（平均随访期：12.8个月）评估膝关节和踝关节的运动学以及膝关节的动力学。该研究获得了当地伦理委员会的批准。早发型GR的肢体术后膝反屈减少了11.1°（p<0.001），晚发型GR的肢体减少了6.0°（p<0.049）。术前，早发型GR的肢体表现出增加的外部伸展力矩，术后显著降低。相比之下，晚发型GR的肢体这些力矩没有显著降低。本研究结果强调了马蹄足作为早发型GR潜在因素的影响。由于马蹄足归因于早期膝过伸，且近端因素在晚发型GR中作为潜在因素更为重要，将GR分为早发型和晚发型有助于识别潜在因素并选择适当的治疗方法。
