Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy -
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy -
Eur J Phys Rehabil Med. 2019 Apr;55(2):250-257. doi: 10.23736/S1973-9087.18.05326-1. Epub 2018 Aug 27.
In children with spastic cerebral palsy (CP), the treatment of equinus foot with Achilles tendon lengthening (ATL) surgery is associated with high incidence of overcorrection, which may result in crouch gait.
We aimed to assess if gait pattern in preoperative time could be a predictor of the surgery outcome.
Cross-sectional retrospective study.
Movement Analysis Lab of IRCCS San Raffaele Pisana Hospital in Rome (Italy).
Eighteen children (mean age 9.6±4.7 years) with spastic diplegia CP who underwent bilateral ATL surgery to correct equinus foot were involved.
Participants underwent 3D gait analysis before and approximately 12 months after surgery. Primary measures were spatiotemporal, kinematic (summarized by Gait Variable Scores, GVSs) and kinetic parameters. The gait patterns for each leg was defined from kinematic data, using a quantitative classification: plantar flexor knee extension (PFKE) index. The CP group was split into true equinus and jump gait.
The equinus foot was successfully corrected as demonstrated by the improvement of GVS ankle dorsi-plantarflexion. However, there was a high rate of overcorrection in the true equinus, characterized by increases in knee flexion-extension GVS (8.7° pre vs. 16.7° post P<0.05) and knee flexion angle at initial contact (5.2° vs. 20.6° P<0.05) and by a decrease in the maximum ankle power generated at push-off (1.49 vs. 0.83 W/kg P<0.05).
Assessment of motor phenotype in preoperative time are good predictors of the results of ATL surgery. In children with true equinus gait, the increase of knee flexion subsequent to ATL is an early indicator that this technique will lead to crouch gait. These results show the influence of true equinus and jump gait patterns on the outcomes of the ATL.
Therefore, we propose that this approach could have clinical value to evaluate and prescribe rehabilitation in children with CP disease, proposing different solutions depending on motor phenotype.
在痉挛性脑瘫（CP）患儿中，跟腱延长术（ATL）治疗马蹄足会导致高比例的过度矫正，这可能导致蹲伏步态。
我们旨在评估术前步态模式是否可作为手术结果的预测指标。
横断面回顾性研究。
意大利罗马圣拉斐尔皮萨纳医院的运动分析实验室。
18 名痉挛性双瘫 CP 患儿（平均年龄 9.6±4.7 岁），接受双侧 ATL 手术以矫正马蹄足。
参与者在术前和术后约 12 个月接受 3D 步态分析。主要测量指标包括时空、运动学（以步态变量评分，GVS 总结）和动力学参数。使用定量分类法（跖屈膝伸指数）从运动学数据中定义每条腿的步态模式。CP 组分为真性马蹄足和跳跃步态。
GVS 踝背屈-跖屈的改善表明马蹄足得到成功矫正。然而，真性马蹄足存在高比例的过度矫正，其特征为膝关节屈伸 GVS 增加（8.7°术前比 16.7°术后，P<0.05）和初始接触时膝关节屈曲角度增加（5.2°比 20.6°，P<0.05），以及在蹬离时最大踝关节功率降低（1.49 比 0.83 W/kg，P<0.05）。
术前运动表型的评估是 ATL 手术结果的良好预测指标。在真性马蹄足患儿中，ATL 后膝关节屈曲增加是该技术将导致蹲伏步态的早期指标。这些结果表明真性马蹄足和跳跃步态模式对 ATL 结果的影响。
因此，我们建议这种方法可能对评估和制定 CP 患儿的康复方案具有临床价值，根据运动表型提出不同的解决方案。
