Romei Marianna, Oudenhoven Laura M, van Schie Petra E M, van Ouwerkerk Willem J R, van der Krogt Marjolein M, Buizer Annemieke I
Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands.
Gait Posture. 2018 Jul;64:108-113. doi: 10.1016/j.gaitpost.2018.06.002. Epub 2018 Jun 4.
Short-term benefit on gait of selective dorsal rhizotomy (SDR) surgery, which relieves spasticity of the lower extremities has been demonstrated in children with cerebral palsy (CP). However very little is known of the evolution of gait when patients become adolescents and young adults.
How does the gait pattern evolve in adolescents and young adults who underwent SDR during childhood?
A longitudinal study was performed including 19 ambulant patients with spastic diplegia due to CP or other causes (mean age at SDR: 6.6 ± 1.6 years) who were assessed four times: pre-SDR, 2 years post- SDR, 5 years post-SDR and at least 10 years post-SDR. From 2D video recordings, Edinburgh Visual Gait Score and lower limb joint kinematic parameters were calculated.
Our data show that the improvement in the gait pattern obtained short-term after SDR continues during into adolescence and adulthood. Ten years after SDR all patients improved compared to baseline. Considering the lower limb joint kinematics, most notable improvements were found at knee and ankle joints. Compared to the evaluation before SDR, the range of motion of the knee increased: the knee was more extended at initial contact and knee flexion in midswing improved. Excessive ankle plantar flexion was reduced during the entire gait cycle. Only minor changes were found at hip and pelvis. Eight patients underwent additional orthopaedic surgery in the years after SDR, and the present findings should be considered as a combination of SDR, development and additional treatment.
We demonstrate lasting improvement of gait quality in ambulant patients with spastic diplegia who underwent SDR during childhood when they become adolescents and young adults.
选择性背根切断术（SDR）手术可缓解下肢痉挛，已证实该手术对脑瘫（CP）患儿的步态有短期益处。然而，对于这些患者成长为青少年和青年成人时步态的演变情况却知之甚少。
童年期接受SDR手术的青少年和青年成人的步态模式如何演变？
进行了一项纵向研究，纳入19例因CP或其他原因导致痉挛性双侧瘫的能行走患者（SDR手术时的平均年龄：6.6±1.6岁），对其进行了四次评估：SDR术前、SDR术后2年、SDR术后5年以及至少SDR术后10年。通过二维视频记录计算爱丁堡视觉步态评分和下肢关节运动学参数。
我们的数据表明，SDR术后短期内获得的步态模式改善在青少年期和成年期仍持续存在。SDR术后10年，所有患者与基线相比均有改善。考虑到下肢关节运动学，在膝关节和踝关节发现了最显著的改善。与SDR术前评估相比，膝关节的活动范围增加：初始接触时膝关节伸展更多，摆动中期膝关节屈曲改善。在整个步态周期中，踝关节过度跖屈减少。在髋关节和骨盆处仅发现轻微变化。8例患者在SDR术后数年接受了额外的骨科手术，本研究结果应被视为SDR、发育和额外治疗的综合结果。
我们证明了童年期接受SDR手术的痉挛性双侧瘫能行走患者在成长为青少年和青年成人时步态质量持续改善。
