Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
Department of Bioengineering, Stanford University, Stanford, CA, USA.
Sci Rep. 2018 Nov 5;8(1):16344. doi: 10.1038/s41598-018-33962-2.
Single-event multilevel surgery (SEMLS) is a standard treatment approach aimed at improving gait for patients with cerebral palsy, but the effect of this approach compared to natural progression without surgical intervention is unclear. In this study, we used retrospective patient history, physical exam, and three-dimensional gait analysis data from 2,333 limbs to build regression models estimating the effect of SEMLS on gait, while controlling for expected natural progression. Post-hoc classifications using the regression model results identified which limbs would exhibit gait within two standard deviations of typical gait at the follow-up visit with or without a SEMLS with 73% and 77% accuracy, respectively. Using these models, we found that, while surgery was expected to have a positive effect on 93% of limbs compared to natural progression, in only 37% of limbs was this expected effect a clinically meaningful improvement. We identified 26% of the non-surgically treated limbs that may have shown a clinically meaningful improvement in gait had they received surgery. Our models suggest that pre-operative physical therapy focused on improving biomechanical characteristics, such as walking speed and strength, may improve likelihood of positive surgical outcomes. These models are shared with the community to use as an evaluation tool when considering whether or not a patient should undergo a SEMLS.
单事件多水平手术（SEMLS）是一种标准的治疗方法，旨在改善脑瘫患者的步态，但这种方法与未经手术干预的自然进展相比的效果尚不清楚。在这项研究中，我们使用了 2333 条肢体的回顾性患者病史、体格检查和三维步态分析数据，建立了回归模型来估计 SEMLS 对步态的影响，同时控制了预期的自然进展。使用回归模型结果进行的事后分类确定了哪些肢体在随访时的步态将在两个典型步态标准差范围内，无论是否进行 SEMLS，其准确率分别为 73%和 77%。使用这些模型，我们发现，虽然与自然进展相比，手术预计对 93%的肢体有积极影响，但只有 37%的肢体的预期效果是有临床意义的改善。我们发现，26%的未经手术治疗的肢体，如果接受手术，可能会在步态上有明显的改善。我们的模型表明，术前物理治疗侧重于改善生物力学特征，如行走速度和力量，可能会提高手术结果的可能性。这些模型与社区共享，用作在考虑患者是否应进行 SEMLS 时的评估工具。
