Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi 13620, Republic of Korea.
Department of Mathematics / AI & Data Science, College of Natural Sciences, Ajou University, Gyeonggi, Republic of Korea.
Gait Posture. 2020 Jul;80:101-105. doi: 10.1016/j.gaitpost.2020.05.033. Epub 2020 May 25.
Pathologic gait is common in patients with cerebral palsy (CP). Single-event multilevel surgery (SEMLS) is a combination of surgical procedures to improve pathologic gait in patients with CP. However, the effect of each procedure is difficult to predict. The gait deviation index (GDI) is useful in comparing pre- and postoperative improvement.
In this study, we evaluated the degree of GDI improvement in patients with CP and analyzed factors related to surgical outcomes.
We screened patients seen between May 2003 and December 2019 via a clinical data warehouse to identify those with CP who had been followed up for >1 year and who had undergone SEMLS. The inclusion criteria were (1) CP patients with GMFCS levels I, II and III, (2) patients who underwent SEMLS, (3) and patients who underwent 3D gait analyses preoperatively and at least 1 year postoperatively. A linear mixed model was used to model GDI improvement, assess effects of covariates, and examine factors that contributed to improvement.
Overall, 544 patients were included. The average improvement in overall GDI was 8.9 ± 12.3, 9.6 ± 12.0, and 6.4 ± 8.6 in Gross Motor Function Classification System (GMFCS) levels I, II, and III, respectively. In GMFCS level II patients, GDI improvement decreased by 0.26 points with a 1-year delay in surgery (p = 0.0022). Within each group of GMFCS levels, femoral derotation osteotomy (FDO) was a significant factor in GDI improvement in GMFCS levels I and II. Rectus femoris transfer (RFT) and supracondylar extension osteotomy (SCO) were significant factors in GMFCS level II. No single procedure was shown to affect improvement in GMFCS level III.
Postoperative GDI improved in all levels of GMFCS. Particular procedures especially affected postoperative improvement in GDI in levels I and II. Our data do not mean to set an indication for particular procedures; however, in GMFCS levels I, II patients, particular procedures, such as FDO, yielded a greater GDI improvement in our data set.
脑瘫（CP）患者常出现病理性步态。单部位多次手术（SEMLS）是一种联合手术方式，旨在改善 CP 患者的病理性步态。但是，每个手术的效果都难以预测。步态偏离指数（GDI）可用于比较术前和术后的改善程度。
本研究旨在评估 CP 患者的 GDI 改善程度，并分析与手术结果相关的因素。
我们通过临床数据仓库筛选了 2003 年 5 月至 2019 年 12 月间就诊的患者，以确定接受 SEMLS 治疗、随访时间超过 1 年且术前和术后至少 1 年均行三维步态分析的 CP 患者。纳入标准为：（1）GMFCS Ⅰ、Ⅱ和Ⅲ级 CP 患者；（2）接受 SEMLS 治疗；（3）术前和术后至少 1 年均行三维步态分析。采用线性混合模型来模拟 GDI 改善程度，评估协变量的影响，并分析有助于改善的因素。
共纳入 544 例患者。总体而言，整体 GDI 平均改善 8.9±12.3、9.6±12.0 和 6.4±8.6，分别对应 GMFCS Ⅰ、Ⅱ和Ⅲ级。GMFCS Ⅱ级患者中，手术时间每延迟 1 年，GDI 改善减少 0.26 分（p=0.0022）。在每个 GMFCS 级别组内，股骨旋截术（FDO）是 GMFCS Ⅰ和Ⅱ级 GDI 改善的重要因素。股直肌转位术（RFT）和髁上伸展截骨术（SCO）是 GMFCS Ⅱ级的重要因素。无单一手术可影响 GMFCS Ⅲ级的改善。
所有 GMFCS 级别患者术后 GDI 均改善。特定手术程序特别影响 GMFCS Ⅰ和Ⅱ级的术后 GDI 改善。本研究数据并非旨在为特定手术程序设定适应证；然而，在 GMFCS Ⅰ、Ⅱ级患者中，FDO 等特定手术在本研究数据集中可使 GDI 得到更大程度的改善。
