Schmid Stefan, Romkes Jacqueline, Taylor William R, Lorenzetti Silvio, Brunner Reinald
ETH Zurich, Institute for Biomechanics, Zurich, Switzerland; Bern University of Applied Sciences, Health Division, Bern, Switzerland.
University of Basel Children's Hospital, Laboratory for Movement Analysis, Basel, Switzerland.
Gait Posture. 2016 Sep;49:457-462. doi: 10.1016/j.gaitpost.2016.08.013. Epub 2016 Aug 12.
Foot equinus and leg length discrepancy (LLD) are common problems in hemiplegic cerebral palsy (hCP), both causing secondary deviations of pelvic motion during gait. It can therefore be assumed that the spinal deviations observed in hCP patients are secondary as a compensation for the position of the pelvis arising from the disturbed leg function. This study investigated the effects of correcting lower extremity function by orthotics on spinal gait kinematics in hCP patients.
Ten adolescent hCP patients and 15 healthy controls were included. Using a validated and previously used enhanced marker set, sagittal and frontal plane spinal curvature angles as well as general trunk and lower extremity kinematics were measured while walking barefoot as well as with an orthotic correction (only hCP patients) using a 12-camera motion capture system.
The hCP patients in both the barefoot and orthotic conditions indicated clinically relevant greater lumbar lordosis angles (d≥0.96, p≤0.071), smaller thoracic kyphosis angles (d≥0.84, p≤0.142) and differences in frontal plane lumbar curvature angles (d≥1.00, p≤0.105) compared to controls. However, these angles were not influenced by the successful restoration of a normal heel-to-toe gait pattern and the correction of any LLD using lower extremity orthotics.
Spinal gait deviations in adolescents with mild hCP seemed not to result secondarily from foot equinus or LLD, but probably from structural deformities such as hip flexor contractures. Future research should address long-term effects of an AFO treatment as well as the relationship between spinal kinematics and severity of disease.
足马蹄内翻和腿长差异（LLD）是偏瘫型脑瘫（hCP）中的常见问题，二者均会导致步态期间骨盆运动的继发性偏差。因此，可以假定在hCP患者中观察到的脊柱偏差是继发性的，是对因腿部功能紊乱而导致的骨盆位置的一种代偿。本研究调查了通过矫形器矫正下肢功能对hCP患者脊柱步态运动学的影响。
纳入10名青少年hCP患者和15名健康对照者。使用经过验证且先前使用过的增强型标记集，在患者赤脚行走以及使用矫形器矫正时（仅hCP患者），采用12台摄像机的运动捕捉系统测量矢状面和额状面的脊柱曲率角度以及一般躯干和下肢的运动学。
与对照组相比，hCP患者在赤脚和使用矫形器的情况下，均显示出临床上相关的更大的腰椎前凸角度（d≥0.96，p≤0.071）、更小的胸椎后凸角度（d≥0.84，p≤0.142）以及额状面腰椎曲率角度的差异（d≥1.00，p≤0.105）。然而，这些角度并未受到正常足跟到足尖步态模式的成功恢复以及使用下肢矫形器对任何腿长差异的矫正的影响。
轻度hCP青少年的脊柱步态偏差似乎并非继发于足马蹄内翻或腿长差异，而可能源于诸如髋屈肌挛缩等结构畸形。未来的研究应关注踝足矫形器治疗的长期效果以及脊柱运动学与疾病严重程度之间的关系。
