Putz C, Wolf S I, Mertens E M, Geisbüsch A, Gantz S, Braatz F, Döderlein L, Dreher T
Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany.
Bone Joint J. 2017 Sep;99-B(9):1256-1264. doi: 10.1302/0301-620X.99B9.BJJ-2016-1155.R1.
A flexed knee gait is common in patients with bilateral spastic cerebral palsy and occurs with increased age. There is a risk for the recurrence of a flexed knee gait when treated in childhood, and the aim of this study was to investigate whether multilevel procedures might also be undertaken in adulthood.
At a mean of 22.9 months (standard deviation 12.9), after single event multi level surgery, 3D gait analysis was undertaken pre- and post-operatively for 37 adult patients with bilateral cerebral palsy and a fixed knee gait.
There was a significant improvement of indices and clinical and kinematic parameters including extension of the hip and knee, reduction of knee flexion at initial contact, reduction of minimum and mean knee flexion in the stance phase of gait, improved range of movement of the knee and a reduction of mean flexion of the hip in the stance phase. Genu recurvatum occurred in two patients (n = 3 legs, 4%) and an increase of pelvic tilt (> 5°) was found in 12 patients (n = 23 legs, 31%).
Adult patients with bilateral cerebral palsy and a flexed knee gait benefit from multilevel surgery including hamstring lengthening. The risk of the occurence of genu recurvatum and increased pelvic tilt is lower than has been previously reported in children. Cite this article: 2017;99-B:1256-64.
屈膝步态在双侧痉挛性脑瘫患者中很常见，且随着年龄增长而出现。儿童期接受治疗后存在屈膝步态复发的风险，本研究的目的是调查成年期是否也可进行多级手术。
37例患有双侧脑瘫且存在固定屈膝步态的成年患者，在平均22.9个月（标准差12.9）时接受单期多级手术后，术前和术后均进行了三维步态分析。
包括髋部和膝部伸展、初始接触时膝关节屈曲减少、步态站立期最小和平均膝关节屈曲减少、膝关节活动范围改善以及站立期髋部平均屈曲减少等指标以及临床和运动学参数均有显著改善。两名患者（n = 3条腿，4%）出现膝反张，12名患者（n = 23条腿，31%）发现骨盆倾斜增加（>5°）。
患有双侧脑瘫且存在屈膝步态的成年患者可从包括腘绳肌延长在内的多级手术中获益。膝反张和骨盆倾斜增加的发生风险低于先前儿童研究报告中的风险。引用本文：2017;99-B:1256 - 64。
