O'Sullivan Rory, Horgan Frances, O'Brien Tim, French Helen
Gait Laboratory, Central Remedial Clinic, Dublin, Ireland; School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
Res Dev Disabil. 2018 Sep;80:84-92. doi: 10.1016/j.ridd.2018.06.013. Epub 2018 Jun 27.
To systematically review the natural history of crouch gait in bilateral cerebral palsy (CP) in the absence of surgical intervention and to review any relationship between clinical variables and progression of knee crouch.
Relevant literature was identified by searching article databases (PubMed, CINAHL, EMBASE, and Web of Science). Included studies reported on participants with bilateral CP who had 3-dimensional gait analysis on at least two occasions with no surgical interventions between analyses.
Five papers (4 retrospective cohort studies; 1 case report) comprised the final selection. Studies varied in follow-up times and participant numbers. Increased knee flexion over time was reported in the four retrospective studies with two distinct patterns of increasing knee flexion evident. Only the case-study reported improved knee extension between assessments. Four studies demonstrated increased hamstring tightness over time with the biggest increases related to longer follow-up time rather than increase in crouch.
The existing literature suggests that the natural history of crouch gait is towards increasing knee flexion over time. Future prospective studies of bigger groups are needed to examine the relationship between increasing crouch and clinical variables.
系统回顾双侧脑瘫（CP）患者在未进行手术干预情况下蹲伏步态的自然病程，并探讨临床变量与膝部蹲伏进展之间的关系。
通过检索文章数据库（PubMed、CINAHL、EMBASE和Web of Science）来确定相关文献。纳入的研究报告了双侧CP患者的情况，这些患者至少进行了两次三维步态分析，且两次分析之间未进行手术干预。
最终筛选出五篇论文（4篇回顾性队列研究；1篇病例报告）。研究的随访时间和参与者数量各不相同。四项回顾性研究报告了随时间推移膝关节屈曲增加，呈现出两种不同的膝关节屈曲增加模式。只有病例研究报告了两次评估之间膝关节伸展有所改善。四项研究表明，随着时间的推移，腘绳肌紧张度增加，最大的增加与更长的随访时间有关，而非蹲伏程度的增加。
现有文献表明，蹲伏步态的自然病程是随着时间的推移膝关节屈曲增加。未来需要对更大规模的群体进行前瞻性研究，以探讨蹲伏增加与临床变量之间的关系。
