Park Hoon, Park Byoung Kyu, Park Kun-Bo, Abdel-Baki Sharkawy Wagih, Rhee Isaac, Kim Chan Woo, Kim Hyun Woo
Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea.
Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan 48108, Korea.
J Clin Med. 2019 Sep 1;8(9):1354. doi: 10.3390/jcm8091354.
Although there have been advancements of surgical techniques to correct gait abnormalities seen in patients with cerebral palsy, the crouch gait remains one of the most difficult problems to treat. The purpose of this retrospective study was to examine our results of distal femoral shortening osteotomy (DFSO) and patellar tendon advancement (PTA), performed in patients with crouch gait associated with severe knee flexion contracture. A total of 33 patients with a mean fixed knee contracture of 38° were included in the study. The mean age at the time of surgery was 12.2 years and the mean follow-up was 26.9 months. The measurements of clinical, radiological, and gait parameters were performed before and after surgery. The mean degrees of knee flexion contracture, Koshino index of patella height, and Gait Deviation Index were found to be significantly improved at the time of final follow-up. The maximum knee extension during the stance phase improved by an average of 25°, and the range of knee motion during gait increased postoperatively. On the other hand, the mean anterior pelvic tilt increased by 9.9°. Also, the maximum knee flexion during the swing phase decreased and the timing of peak knee flexion was observed to be delayed. We conclude that combined procedure of DFSO and PTA is an effective and safe surgical method for treating severe knee flexion contracture and crouch gait. However, the surgeons should be aware of the development of increased anterior pelvic tilt and stiff knee gait after the index operation.
尽管在纠正脑瘫患者步态异常方面手术技术有所进步，但蹲伏步态仍然是最难治疗的问题之一。这项回顾性研究的目的是检查我们对伴有严重膝关节屈曲挛缩的蹲伏步态患者进行股骨远端缩短截骨术（DFSO）和髌腱前移术（PTA）的结果。共有33例平均固定膝关节挛缩38°的患者纳入研究。手术时的平均年龄为12.2岁，平均随访时间为26.9个月。在手术前后进行临床、放射学和步态参数的测量。在末次随访时，发现膝关节屈曲挛缩的平均度数、髌骨高度的小柴指数和步态偏差指数均有显著改善。站立期的最大膝关节伸展平均改善了25°，术后步态期间膝关节活动范围增加。另一方面，平均骨盆前倾增加了9.9°。此外，摆动期的最大膝关节屈曲减少，且观察到膝关节屈曲峰值时间延迟。我们得出结论，DFSO和PTA联合手术是治疗严重膝关节屈曲挛缩和蹲伏步态的一种有效且安全的手术方法。然而，外科医生应注意在初次手术后骨盆前倾增加和膝关节僵硬步态的发展。
