Švehlík M, Steinwender G, Lehmann T, Kraus T
Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria.
Jena University Hospital, Bachstraße 18, Jena, 07743, Germany.
Bone Joint J. 2016 Feb;98-B(2):278-81. doi: 10.1302/0301-620X.98B2.35959.
Single event multilevel surgery (SEMLS) has been shown to improve gait in children with cerebral palsy (CP). However, there is limited evidence regarding long-term outcomes and factors influencing them.
In total 39 children (17 females and 22 males; mean age at SEMLS ten years four months, standard deviation 37 months) with bilateral CP (20 Gross Motor Function Classification System (GMFCS) level II and 19 GMFCS level III) treated with SEMLS were included. Children were evaluated using gait analysis and the Gait Deviation Index (GDI) before SEMLS and one, two to three, five and at least ten years after SEMLS. A linear mixed model was used to estimate the effect of age at the surgery, GMFCS and follow-up period on GDI.
There was a mean improvement of 12.1 (-15.3 to 45.1) GDI points one year after SEMLS (p < 0.001) and 10.3 (-23.1 to 44.2) GDI points ten years after SEMLS compared with before SEMLS (p < 0.001). GMFCS level III children aged ten to 12 years had the most improvement. The GMFCS III group had more surgical procedures at the index SEMLS (p < 0.001) and during the follow-up period (p = 0.039). After correcting for other factors, age at surgery was the only factor predictive of long-term results. Our model was able to explain 45% of the variance of the change in GDI at the different time points.
Children with GMFCS III level aged ten to 12 are the benchmark responders to SEMLS in the long-term.
单事件多节段手术（SEMLS）已被证明可改善脑瘫（CP）儿童的步态。然而，关于其长期疗效及影响因素的证据有限。
纳入39例接受SEMLS治疗的双侧脑瘫儿童（17例女性，22例男性；SEMLS时平均年龄为10岁4个月，标准差37个月），其中20例为粗大运动功能分级系统（GMFCS）II级，19例为GMFCS III级。在SEMLS前以及SEMLS后1年、2至3年、5年和至少10年，使用步态分析和步态偏差指数（GDI）对儿童进行评估。采用线性混合模型估计手术时年龄、GMFCS分级和随访时间对GDI的影响。
与SEMLS前相比，SEMLS后1年GDI平均改善12.1（-15.3至45.1）分（p<0.001），SEMLS后10年GDI平均改善10.3（-23.1至44.2）分（p<0.001）。年龄在10至12岁的GMFCS III级儿童改善最为明显。GMFCS III级组在初次SEMLS时（p<0.001）和随访期间（p = 0.039）接受的手术更多。校正其他因素后，手术时年龄是长期疗效的唯一预测因素。我们的模型能够解释不同时间点GDI变化方差的45%。
年龄在10至12岁的GMFCS III级儿童是SEMLS长期疗效的基准反应者。
