脑瘫患儿中伴发高位髌骨的流行情况及其临床意义。

Patella Alta in Ambulatory Children With Cerebral Palsy: Prevalence and Functional Significance.

机构信息

Shriners Hospital for Children-Northern California, Sacramento, CA.

Shriners Hospital for Children-Greenville, Greenville, SC.

出版信息

J Pediatr Orthop. 2020 Nov/Dec;40(10):e963-e971. doi: 10.1097/BPO.0000000000001664.

DOI:10.1097/BPO.0000000000001664

PMID:32804868

Abstract

BACKGROUND

Gait dysfunction associated with patella alta (PA) in subjects with cerebral palsy (CP) has been presumed but not objectively established clinically or through biomechanical modeling. It is hypothesized that PA is associated with increasing level of motor impairment, increasing age, obesity, and worse stance phase knee kinematics and kinetics in children with CP.

METHODS

Retrospective case series of 297 subjects with CP studied in our Motion Analysis Center. Data analyzed included patient demographics (age, body mass index, CP classification), patella height (Koshino-Sugimoto Index), and knee kinematics and kinetics.

RESULTS

PA was present in 180 of 297 subjects (61%), in 68 of the 146 (47%) with unilateral CP, and 112 of 151 subjects (74%) with bilateral CP. For unilateral CP, the prevalence of PA was not significantly different between Gross Motor Function Classification System (GMFCS) I and II (P=0.357). For bilateral CP, the prevalence of PA in GMFCS III was significantly greater than in GMFCS I and II (P=0.02). Regression analysis showed a significant trend between increasing age and PA in unilateral and bilateral groups (P<0.001 and 0.001, respectively). The prevalence of PA was not significantly different across body mass index categories for either unilateral or bilateral groups. There were only 2 of 10 significant correlations between PA and gait parameters for subjects with unilateral CP functioning at the GMFCS I and II levels. There were 8 of 12 significant correlations between PA and gait parameters for subjects with bilateral CP functioning at the GMFCS I, II, and III levels.

CONCLUSIONS

PA is common in ambulatory children with CP across topographic types and motor functional levels. PA is well tolerated with respect to gait dysfunction in unilateral CP, but may contribute to crouch gait in bilateral CP. Gait dysfunction cannot be inferred from the radiographic assessment of patellar height, and radiographic evidence of PA by itself does not justify surgical correction with patellar tendon advancement or shortening.

LEVEL OF EVIDENCE

Level III-prognostic, retrospective series.

摘要

背景

脑瘫（CP）患者的髌骨高位（PA）与步态功能障碍相关，这一假说已经提出，但尚未通过临床或生物力学建模得到客观证实。假设 PA 与运动障碍程度增加、年龄增长、肥胖以及 CP 患儿更差的站立相膝关节运动学和动力学相关。

方法

对我院运动分析中心 297 例 CP 患者进行回顾性病例系列研究。分析的数据包括患者人口统计学资料（年龄、体重指数、CP 分类）、髌骨高度（Koshino-Sugimoto 指数）以及膝关节运动学和动力学。

结果

297 例患者中有 180 例（61%）存在 PA，其中 146 例（47%）单侧 CP 患者中有 68 例，151 例双侧 CP 患者中有 112 例。对于单侧 CP，Gross Motor Function Classification System（GMFCS）I 级和 II 级患者的 PA 患病率无显著差异（P=0.357）。对于双侧 CP，GMFCS III 级患者的 PA 患病率明显高于 GMFCS I 级和 II 级（P=0.02）。回归分析显示，单侧和双侧 CP 患者的年龄与 PA 之间存在显著趋势（P<0.001 和 0.001）。单侧和双侧 CP 患者的体重指数类别之间的 PA 患病率无显著差异。单侧 CP 患者中，GMFCS I 级和 II 级功能水平有 2 项 PA 与步态参数之间存在显著相关性，GMFCS III 级功能水平有 10 项 PA 与步态参数之间存在显著相关性。双侧 CP 患者中，GMFCS I、II 和 III 级功能水平有 8 项 PA 与步态参数之间存在显著相关性。