Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
Gait Posture. 2020 Jun;79:126-132. doi: 10.1016/j.gaitpost.2020.04.026. Epub 2020 May 1.
Hamstring lengthening remains the most common surgical procedure in the treatment of crouch gait for children with cerebral palsy (CP). While sagittal plane knee kinematics have been shown to improve post-surgery, the effects on transverse plane kinematics have not been reported. Given the differing actions of the medial and lateral hamstring muscles there is potential for change in tibial rotation post hamstring lengthening.
What is the effect of medial only versus combined medial and lateral hamstring lengthening on tibial rotation during gait in children with CP?
A retrospective analysis of children with a diagnosis of CP who underwent a hamstring lengthening procedure. These children were divided into 2 groups: G1 (n = 18) had isolated medial hamstring lengthening while G2 (n = 30) had combined medial and lateral hamstring lengthening. A matched non-surgical control group (n = 15) was also included. Kinematic data were analysed pre and post-operatively. Pre-operative to post-operative outcomes for G1 and G2, a comparison at baseline for both groups and the difference in outcomes between the groups were analysed. Baseline to follow-up outcomes for the control group were also analysed.
External tibial rotation increased significantly within groups (G1: -10°, p < 0.01; G2: -11°, p < 0.001, control: -7.7, p < 0.01), with no significant difference in the change between the intervention groups. Foot progression angles became more external in both intervention groups (G1: -15°, p < 0.001; G2: -15°, p < 0.0001) and did not change in the control group.
Results demonstrated similar increases in external tibial rotation, regardless of whether an isolated medial or combined medial and lateral surgery was performed. The control group demonstrated a similar change in external tibial rotation suggesting that hamstring lengthening surgery does not contribute to increased external tibial rotation in children with CP compared to what would be expected due to natural progression.
在治疗脑瘫（CP）患儿的蹲伏步态时，腘绳肌延长术仍然是最常见的手术。虽然矢状面膝关节运动学在手术后得到了改善，但对横断面运动学的影响尚未报道。由于内侧和外侧腘绳肌的作用不同，腘绳肌延长术后胫骨旋转可能会发生变化。
单纯内侧腘绳肌延长术与内侧和外侧联合腘绳肌延长术对 CP 患儿步态中胫骨旋转的影响有何不同？
对接受腘绳肌延长术的 CP 患儿进行回顾性分析。这些患儿分为 2 组：G1 组（n = 18）行单纯内侧腘绳肌延长术，G2 组（n = 30）行内侧和外侧联合腘绳肌延长术。还纳入了 1 个匹配的非手术对照组（n = 15）。对术前和术后的运动学数据进行分析。对 G1 组和 G2 组的术前至术后结果、两组的基线比较以及两组间结果的差异进行分析。对对照组的基线至随访结果也进行了分析。
组内的胫骨外旋明显增加（G1：-10°，p < 0.01；G2：-11°，p < 0.001，对照组：-7.7°，p < 0.01），干预组间的变化无显著差异。两组干预组的足进路角度均变得更加外旋（G1：-15°，p < 0.001；G2：-15°，p < 0.0001），对照组无变化。
结果表明，无论行单纯内侧还是联合内侧和外侧手术，胫骨外旋的增加均相似。对照组的胫骨外旋也有类似的变化，这表明与自然进展相比，脑瘫患儿的腘绳肌延长术并不会导致胫骨外旋增加。
