Heidelberg University Hospital, Clinic for Orthopedics and Trauma Surgery, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
World J Pediatr. 2019 Jun;15(3):276-280. doi: 10.1007/s12519-019-00238-2. Epub 2019 Mar 4.
Equinus is a common deformity in children with bilateral spastic cerebral palsy (BSCP). While dynamic equinus usually is treated by conservative therapy, fixed contractures need surgical correction. To choose the appropriate surgical method, it is important to discriminate between isolated gastrocnemius shortening and combined gastrosoleus complex contracture.
In a retrospective study 938 patients with BSCP were studied. Patients underwent gait analysis and clinical examination. 248 patients (496 limbs) met the inclusion criteria. Data from motion analysis and clinical examination were used to calculate the prevalence and to further classify fixed equinus foot.
The prevalence of equinus was 83.3%. During clinical exam 246 (59.6%) limbs showed combined gastrosoleus complex contracture and 167 (40.4%) isolated gastrocnemius contracture. Max. DF at stance and mean DF at initial contact were significantly reduced in combined contracture, while max. ROM was increased (P < 0.05).
Corroborating the results of previous studies, in this study there was a high prevalence of fixed equinus in patients with BSCP. The prevalence of equinus correlated with increasing age. As half of the patients with fixed equinus show a different involvement of gastrocnemius and soleus muscle, we recommend to apply Silfverskiöld's test to discriminate between those two types to choose the appropriate surgical therapy.
马蹄内翻足是双侧痉挛性脑瘫（BSCP）患儿常见的畸形。尽管动态马蹄内翻足通常采用保守治疗，但固定性挛缩需要手术矫正。为了选择合适的手术方法，区分单纯腓肠肌缩短和腓肠肌-比目鱼肌复合体联合挛缩非常重要。
在一项回顾性研究中，对 938 例 BSCP 患者进行了研究。患者接受步态分析和临床检查。248 例（496 肢）符合纳入标准。运动分析和临床检查的数据用于计算固定性马蹄内翻足的患病率，并进一步对其进行分类。
马蹄内翻足的患病率为 83.3%。在临床检查中，246 肢（59.6%）显示腓肠肌-比目鱼肌复合体联合挛缩，167 肢（40.4%）显示单纯腓肠肌挛缩。在联合挛缩中，站立时最大背屈角度和初始接触时平均背屈角度显著降低，而最大活动范围增加（P < 0.05）。
与之前的研究结果一致，本研究中 BSCP 患者固定性马蹄内翻足的患病率较高。马蹄内翻足的患病率与年龄的增加有关。由于一半固定性马蹄内翻足患者的腓肠肌和比目鱼肌受累不同，我们建议应用 Silfverskiöld 试验来区分这两种类型，以选择合适的手术治疗。
