Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, British Columbia, Canada.
Dev Med Child Neurol. 2020 Sep;62(9):1047-1053. doi: 10.1111/dmcn.14541. Epub 2020 Apr 19.
To determine whether energy consumption changes after selective dorsal rhizotomy (SDR) among children with cerebral palsy (CP).
We retrospectively evaluated net nondimensional energy consumption during walking among 101 children with bilateral spastic CP who underwent SDR (59 males, 42 females; median age [5th centile, 95th centile] 5y 8mo [4y 2mo, 9y 4mo]) compared to a control group of children with CP who did not undergo SDR. The control group was matched by baseline age, spasticity, and energy consumption (56 males, 45 females; median age [5th centile, 95th centile] 5y 8mo [4y 1mo, 9y 6mo]). Outcomes were compared at baseline and follow-up (SDR: mean [SD] 1y 7mo [6mo], control: 1y 8mo [8mo]).
The SDR group had significantly greater decreases in spasticity compared to matched controls (-42% SDR vs -20% control, p<0.001). While both groups had a modest reduction in energy consumption between visits (-12% SDR, -7% control), there was no difference in change in energy consumption (p=0.11) or walking speed (p=0.56) between groups.
The SDR group did not exhibit greater reductions in energy consumption compared to controls. The SDR group had significantly greater spasticity reduction, suggesting that spasticity had minimal impact on energy consumption during walking in CP. These results support prior findings that spasticity and energy consumption decrease with age in CP. Identifying matched control groups is critical for outcomes research involving children with CP to account for developmental changes.
确定脑瘫（CP）患儿选择性脊神经后根切断术（SDR）后能量消耗是否发生变化。
我们回顾性评估了 101 例双侧痉挛型 CP 患儿 SDR 术后（59 例男性，42 例女性；中位年龄[第 5 百分位数，第 95 百分位数]5y 8mo [4y 2mo，9y 4mo]）与未行 SDR 的 CP 患儿对照组之间行走时净无因次能量消耗。对照组根据基线年龄、痉挛程度和能量消耗进行匹配（56 例男性，45 例女性；中位年龄[第 5 百分位数，第 95 百分位数]5y 8mo [4y 1mo，9y 6mo]）。结果在基线和随访时进行比较（SDR：平均[标准差]1y 7mo [6mo]，对照组：1y 8mo [8mo]）。
SDR 组与匹配对照组相比，痉挛程度明显降低（-42% SDR 与-20% 对照组，p<0.001）。虽然两组在两次就诊之间的能量消耗都有适度减少（-12% SDR，-7% 对照组），但两组之间能量消耗的变化（p=0.11）或行走速度（p=0.56）无差异。
SDR 组与对照组相比，能量消耗并未明显降低。SDR 组痉挛程度明显降低，提示痉挛对 CP 患儿行走时的能量消耗影响较小。这些结果支持先前的研究结果，即痉挛和能量消耗随 CP 患儿年龄增长而降低。为了 CP 患儿的结局研究，识别匹配的对照组非常重要，以解释发育变化。
