Ganjwala Dhiren, Shah Hitesh
Department of Pediatric Orthopedics, Ganjwala Orthopaedic Hospital, Ahmedabad, Gujarat, India.
Department of Pediatric Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Indian J Orthop. 2019 Jan-Feb;53(1):53-62. doi: 10.4103/ortho.IJOrtho_339_17.
Two common knee problems in cerebral palsy are increased knee flexion during stance phase and reduced knee flexion during the swing phase of gait. We reviewed the recent literature and based on that, we formed this review. Hamstring spasticity, quadriceps weakness, soleus weakness, and lever-arm dysfunction are few factors which lead to increased knee flexion during stance phase. Rectus spasticity diminishes knee flexion in the swing. Resulting gait-stiff knee gait interferes with ground clearance. Both gait patterns result into esthetically poor gait and increased energy consumption. Knee flexion gait may lead to pain in the knee. Natural history of knee flexion gait suggests deterioration over time. In the early stage, these gait abnormalities are managed by nonoperative treatment. Cases in which nonoperative measures fail or advance cases need surgical treatment. Various variables which are taken into consideration before selecting a particular treatment option are described. We also present an algorithm for decision-making. Nonsurgical options and surgical procedures are discussed.
脑瘫患者常见的两种膝关节问题是站立期膝关节屈曲增加以及步态摆动期膝关节屈曲减少。我们查阅了近期文献，并在此基础上形成了本综述。腘绳肌痉挛、股四头肌无力、比目鱼肌无力以及力臂功能障碍是导致站立期膝关节屈曲增加的几个因素。股直肌痉挛会减少摆动期的膝关节屈曲。由此产生的步态——僵硬膝关节步态会影响离地间隙。这两种步态模式都会导致美观性差的步态以及能量消耗增加。膝关节屈曲步态可能会导致膝关节疼痛。膝关节屈曲步态的自然病程表明其会随时间恶化。在早期阶段，这些步态异常通过非手术治疗进行处理。非手术措施失败的病例或病情进展的病例需要手术治疗。文中描述了在选择特定治疗方案之前需要考虑的各种变量。我们还提出了一种决策算法。讨论了非手术选择和手术程序。
