Zhou J Y, Lowe E, Cahill-Rowley K, Mahtani G B, Young J L, Rose J
Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA and Motion & Gait Analysis Laboratory, Lucile Salter Packard Children's Hospital, Palo Alto, CA, USA.
Motion & Gait Analysis Laboratory, Lucile Salter Packard Children's Hospital, Palo Alto, CA, USA.
J Child Orthop. 2019 Feb 1;13(1):73-81. doi: 10.1302/1863-2548.13.180013.
Spastic cerebral palsy (CP) is characterized by four neuromuscular deficits: weakness, short muscle-tendon unit, muscle spasticity and impaired selective motor control (SMC). We examined the influence of impaired SMC on gait in children with bilateral spastic CP. Delineating the influence of neuromuscular deficits on gait abnormalities can guide surgical and therapeutic interventions to reduce long-term debilitating effects of CP.
The relationship between impaired SMC and gait was assessed using multivariate linear regression analysis of Selective Control Assessment of the Lower Extremity (SCALE) in relation to stance phase knee flexion and temporal-spatial gait parameters calculated using 3D kinematics for 57 children with bilateral spastic CP, ages seven to 11 years.
Mean SCALE values were 5.8 (0 to 10, sd 3.0) and 5.7 (0 to 10, sd 2.9) for right and left legs, respectively. Multivariate linear regression models, including right and left SCALE and height, significantly predicted right and left knee flexion at initial contact (R = 0.479, p = 0.003; R = 0.452, p = 0.007, respectively) and right and left knee flexion in midstance (R = 0.428, p = 0.013; R = 0.407, p = 0.022, respectively). The model significantly predicted right and left step length (R = 0.645, p = 0.000; R = 0.523, p = 0.001, respectively) and predicted gait velocity (R = 0.444, p = 0.008). The model including SCALE did not predict step width.
Results indicate impaired SMC predicts increased knee flexion at initial contact, and reduces step length and velocity. Understanding the influence of impaired SMC on gait can inform decisions regarding therapy and surgery, such as hamstring lengthening.
Level II Retrospective Study.
痉挛型脑瘫（CP）具有四种神经肌肉缺陷：肌无力、肌腱单位短缩、肌肉痉挛以及选择性运动控制（SMC）受损。我们研究了SMC受损对双侧痉挛型CP患儿步态的影响。明确神经肌肉缺陷对步态异常的影响能够指导手术和治疗干预，以减轻CP的长期致残影响。
采用多变量线性回归分析，评估下肢选择性控制评估量表（SCALE）与57例7至11岁双侧痉挛型CP患儿的站立相膝关节屈曲以及使用三维运动学计算的时空步态参数之间的关系。
右下肢和左下肢的平均SCALE值分别为5.8（0至10，标准差3.0）和5.7（0至10，标准差2.9）。多变量线性回归模型，包括左右SCALE和身高，显著预测了初始接触时左右膝关节的屈曲（分别为R = 0.479，p = 0.003；R = 0.452，p = 0.007）以及站立中期左右膝关节的屈曲（分别为R = 0.428，p = 0.013；R = 0.407，p = 0.022）。该模型显著预测了左右步长（分别为R = 0.645，p = 0.000；R = 0.523，p = 0.001）并预测了步态速度（R = 0.444，p = 0.008）。包含SCALE的模型未预测步宽。
结果表明SMC受损预示着初始接触时膝关节屈曲增加，并会缩短步长和降低速度。了解SMC受损对步态的影响可为治疗和手术决策提供参考，例如腘绳肌延长术。
二级回顾性研究。
