de Morais Filho Mauro César, Blumetti Francesco Camara, Kawamura Cátia Miyuki, Ferreira Cássio Luís, Lopes José Augusto Fernandes, Fujino Marcelo Hideki, Neves Daniella Lins
Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil.
Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil.
Gait Posture. 2018 Oct;66:32-37. doi: 10.1016/j.gaitpost.2018.08.014. Epub 2018 Aug 18.
Muscle imbalance is related to persistent internal hip rotation (IHR) after femoral derotation osteotomy (FDO) in cerebral palsy (CP). The aim of this study was to evaluate the effect of the Majestro-Frost soft tissue procedure (MFP), which potentially addresses muscle imbalance, on IHR in CP patients during walking.
A retrospective study of an existing database (medical records and gait laboratory data) was conducted and a search was performed using the following inclusion criteria: (1) diagnosis of spastic CP, (2) GMFCS levels I-III; (3) mean IHR during stance phase higher than 11° at baseline; (4) individuals who received single event multilevel orthopedic surgery in the lower limbs and had three-dimensional gait analyses (3DGA) before and after the intervention. Patients who underwent a FDO were excluded. Eighty-three individuals were considered for the study and they were divided into two groups: No MFP (45 patients who did not receive a MFP) and MFP (36 patients who underwent a MFP). A full clinical examination and 3DGA, with kinematics calculated according to a standard software procedure (Plugin Gait), were performed before and after the intervention, and the results were compared.
The studied groups matched regarding demographic data and GMFCS distribution. The mean follow-up time was more than 20 months on both groups. The increase of clinical external hip rotation (EHR) on physical examination was observed only in the MFP group (from 26.4° to 33°, p = 0.002). During gait analysis, IHR decreased from 21.2° to 4.5° in the MFP group (p < 0.001) and from 16.9° to 7.9° in the No MFP group (p < 0.001). The reduction of IHR during gait was more significant in the MFP group (p = 0.001).
In the present study, patients who underwent a MFP showed more reduction of IHR during gait than those which did not undergo a MFP.
肌肉失衡与脑瘫（CP）患者股骨旋转截骨术（FDO）后持续的内髋旋转（IHR）有关。本研究的目的是评估可能解决肌肉失衡问题的Majestro-Frost软组织手术（MFP）对CP患者行走时IHR的影响。
对现有数据库（病历和步态实验室数据）进行回顾性研究，并使用以下纳入标准进行检索：（1）痉挛性CP诊断；（2）GMFCS分级I-III级；（3）基线时站立期平均IHR高于11°；（4）接受过下肢单期多节段骨科手术且在干预前后进行过三维步态分析（3DGA）的个体。接受FDO的患者被排除。83名个体被纳入研究，分为两组：未行MFP组（45例未接受MFP的患者）和MFP组（36例行MFP的患者）。在干预前后进行全面的临床检查和3DGA，并根据标准软件程序（Plugin Gait）计算运动学数据，比较结果。
研究组在人口统计学数据和GMFCS分布方面相匹配。两组的平均随访时间均超过20个月。仅在MFP组观察到体格检查时临床外髋旋转（EHR）增加（从26.4°增至33°，p = 0.002）。在步态分析中，MFP组的IHR从21.2°降至4.5°（p < 0.001），未行MFP组从16.9°降至7.9°（p < 0.001）。MFP组步态期间IHR的降低更为显著（p = 0.001）。
在本研究中，行MFP的患者在步态期间IHR的降低比未行MFP的患者更明显。
