Skaaret I, Steen H, Huse A B, Holm I
Department for Child Neurology, Oslo University Hospital, Oslo, Norway.
Medical Faculty, Department of Interdisciplinary Health Science, University of Oslo, Oslo, Norway.
J Child Orthop. 2019 Apr 1;13(2):180-189. doi: 10.1302/1863-2548.13.180146.
Children with spastic unilateral cerebral palsy (SUCP) frequently undergo lower limb surgery to improve gait. Postoperatively, ankle-foot orthoses (AFOs) are used to maintain the surgical corrections and provide adequate mechanical support. Our aim was to evaluate changes in gait and impacts of AFOs one-year postoperatively.
In all, 33 children with SUCP, 17 girls and 16 boys, mean age 9.2 years (5 to 16.5) were measured by 3D gait analysis walking barefoot preoperatively and walking barefoot and with AFOs one-year postoperatively. Changes in Gait Profile Scores (GPS), kinematic, kinetic and temporal spatial variables were examined using linear mixed models, with gender, gross motor function and AFO type as fixed effects.
The results confirm significant gait improvements in the GPS, kinematics and kinetics walking barefoot one year after surgery. Comparing AFOs with barefoot walking postoperatively, there was additionally reduced ankle plantarflexion by an average of 5.1° and knee flexion by 4.7° at initial contact, enhanced ankle moments during loading response, increased velocity, longer steps and inhibited push-off power generation. Stance and swing phase dorsiflexion increased in children walking with hinged AFOs children walking with ground reaction AFOs. Changes in the non-affected limbs indicated less compensatory gait postoperatively.
Major changes were found between pre- and postoperative barefoot conditions. The main impact of AFOs was correction of residual drop foot and improved prepositioning for initial contact, which could be considered as indications for continued use after the one-year follow-up.
Level II - Therapeutic.
痉挛性单侧脑瘫（SUCP）患儿常接受下肢手术以改善步态。术后，使用踝足矫形器（AFO）来维持手术矫正效果并提供足够的机械支撑。我们的目的是评估术后一年步态的变化以及AFO的影响。
总共33例SUCP患儿，17名女孩和16名男孩，平均年龄9.2岁（5至16.5岁），术前进行了三维步态分析测量其赤足行走情况，术后一年测量其赤足行走以及佩戴AFO行走的情况。使用线性混合模型检查步态轮廓评分（GPS）、运动学、动力学和时空变量的变化，将性别、粗大运动功能和AFO类型作为固定效应。
结果证实术后一年赤足行走时，GPS、运动学和动力学方面的步态有显著改善。将术后佩戴AFO行走与赤足行走进行比较，初始接触时踝关节跖屈平均减少5.1°，膝关节屈曲减少4.7°，负重反应期间踝关节力矩增强，速度增加，步长更长，且蹬离力量产生受到抑制。佩戴铰链式AFO行走的儿童和佩戴地面反应性AFO行走的儿童在站立相和摆动相背屈增加。未受影响肢体的变化表明术后代偿性步态减少。
术前和术后赤足状态之间发现了重大变化。AFO的主要影响是纠正残留的垂足并改善初始接触时的预定位，这可被视为一年随访后继续使用的指征。
二级——治疗性。
