EA 7377 BIOTN, Université Paris Est Créteil (UPEC), Créteil, France.
AP-HP, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France.
Biomed Res Int. 2018 May 21;2018:2328601. doi: 10.1155/2018/2328601. eCollection 2018.
Muscle shortening and spastic cocontraction in ankle plantar flexors may alter gait since early childhood in cerebral palsy (CP). We evaluated gastrosoleus complex (GSC) length, and gastrocnemius medialis (GM) and peroneus longus (PL) activity during swing phase, in very young hemiparetic children with equinovalgus.
This was an observational, retrospective, and monocentric outpatient study in a pediatric hospital. Ten very young hemiparetic children (age 3 ± 1 yrs) were enrolled. These CP children were assessed for muscle extensibility (Tardieu scale ) in GSC (angle of arrest during slow-speed passive ankle dorsiflexion with the knee extended) and monitored for GM and PL electromyography (EMG) during the swing phase of gait. The swing phase was divided into three periods (T1, T2, and T3), in which we measured a cocontraction index (CCI), ratio of the Root Mean Square EMG (RMS-EMG) from each muscle during that period to the peak 500 ms RMS-EMG obtained from voluntary plantar flexion during standing on tiptoes (from several 5-second series, the highest RMS value was computed over 500 ms around the peak).
On the paretic side: (i) the mean was 100° (8°) (median (SD)) versus 106° (3°) on the nonparetic side ( = 0.032, Mann-Whitney); (ii) diminished with age between ages of 2 and 5 (Spearman, = 0.019); (iii) CCI and CCI during swing phase were higher than on the nonparetic side (CCI, 0.32 (0.20) versus 0.15 (0.09), < 0.01; CCI, 0.52 (0.30) versus 0.24 (0.17), < 0.01), with an early difference significant for PL from T1 ( = 0.03).
In very young hemiparetic children, the paretic GSC may rapidly shorten in the first years of life. GM and PL cocontraction during swing phase are excessive, which contributes to dynamic equinovalgus. Muscle extensibility () may have to be monitored and preserved in the first years of life in children with CP. Additional measurements of cocontraction may further help target treatments with botulinum toxin, especially in peroneus longus.
在脑瘫（CP）患儿中，踝关节跖屈肌的肌肉缩短和痉挛性共收缩可能从幼年开始改变步态。我们评估了非常年轻的偏瘫患儿在马蹄内翻时，摆动相期间的比目鱼肌-跟腱复合体（GSC）长度和腓肠肌内侧（GM）和腓骨长肌（PL）的活动。
这是一项在儿童医院进行的观察性、回顾性、单中心门诊研究。纳入了 10 名非常年轻的偏瘫患儿（年龄 3 ± 1 岁）。评估这些 CP 患儿的肌肉伸展性（Tardieu 量表）在 GSC（伸膝时慢速被动踝背屈过程中角度的阻滞），并监测 GM 和 PL 肌电图（EMG）在步态摆动相期间。摆动相分为三个时期（T1、T2 和 T3），在此期间我们测量了协同收缩指数（CCI），即该期间每个肌肉的均方根 EMG（RMS-EMG）与从踮脚尖站立时 500 ms 内自愿跖屈获得的最高 500 ms RMS-EMG（来自几个 5 秒系列，在峰值周围的 500 ms 内计算最高 RMS 值）的比值。
在患侧：（i）均值为 100°（8°）（中位数（SD）），而非患侧为 106°（3°）（ = 0.032，曼-惠特尼）；（ii）随年龄变化在 2 至 5 岁之间减小（Spearman， = 0.019）；（iii）摆动相期间的 CCI 和 CCI 高于非患侧（CCI，0.32（0.20）对 0.15（0.09）， ＜0.01；CCI，0.52（0.30）对 0.24（0.17）， ＜0.01），PL 从 T1 开始就存在显著差异（ = 0.03）。
在非常年轻的偏瘫患儿中，患侧 GSC 可能在生命的最初几年迅速缩短。GM 和 PL 在摆动相期间的协同收缩过多，这导致了动态马蹄内翻。肌肉伸展性（ ）可能需要在 CP 患儿的生命最初几年进行监测和保持。协同收缩的进一步测量可能有助于针对肉毒杆菌毒素治疗的目标，特别是针对腓骨长肌。
