Edwards Tomos A, Thompson Nicky, Prescott Robin J, Stebbins Julie, Wright James G, Theologis Tim
Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK.
Centre for Population Health Sciences, Usher Institute, Edinburgh, UK.
Bone Joint J. 2021 Jan;103-B(1):192-197. doi: 10.1302/0301-620X.103B1.BJJ-2020-0714.R1.
To compare changes in gait kinematics and walking speed 24 months after conventional (C-MLS) and minimally invasive (MI-MLS) multilevel surgery for children with diplegic cerebral palsy (CP).
A retrospective analysis of 19 children following C-MLS, with mean age at surgery of 12 years five months (seven years ten months to 15 years 11 months), and 36 children following MI-MLS, with mean age at surgery of ten years seven months (seven years one month to 14 years ten months), was performed. The Gait Profile Score (GPS) and walking speed were collected preoperatively and six, 12 and 24 months postoperatively. Type and frequency of procedures as part of MLS, surgical adverse events, and subsequent surgery were recorded.
In both groups, GPS improved from the preoperative gait analysis to the six-month assessment with maintenance at 12 and 24 months postoperatively. While reduced at six months in both groups, walking speed returned to preoperative speed by 12 months. The overall pattern of change in GPS and walking speed was similar over time following C-MLS and MI-MLS. There was a median of ten procedures per child as part of both C-MLS (interquartile range (IQR) 8.0 to 11.0) and MI-MLS (IQR 7.8 to 11.0). Surgical adverse events occurred in seven (37%) and 13 (36%) children, with four (21%) and 13 (36%) patients requiring subsequent surgery following C-MLS and MI-MLS, respectively.
This study indicates similar improvements in gait kinematics and walking speed 24 months after C-MLS and MI-MLS for children with diplegic CP. Cite this article: 2021;103-B(1):192-197.
比较传统多级手术（C-MLS）和微创多级手术（MI-MLS）治疗双侧痉挛型脑瘫（CP）患儿24个月后的步态运动学变化和步行速度。
对19例接受C-MLS手术的儿童进行回顾性分析，手术时平均年龄为12岁5个月（7岁10个月至15岁11个月），以及36例接受MI-MLS手术的儿童，手术时平均年龄为10岁7个月（7岁1个月至14岁10个月）。术前以及术后6个月、12个月和24个月收集步态轮廓评分（GPS）和步行速度。记录作为多级手术一部分的手术类型和频率、手术不良事件及后续手术情况。
两组中，GPS从术前步态分析到6个月评估时均有改善，并在术后12个月和24个月保持稳定。两组在6个月时步行速度均降低，但到12个月时恢复到术前速度。C-MLS和MI-MLS术后，GPS和步行速度随时间的总体变化模式相似。作为C-MLS和MI-MLS一部分，每名儿童的手术中位数均为10次（四分位间距（IQR）分别为8.0至11.0和7.8至11.0）。7例（37%）和13例（36%）儿童发生手术不良事件，C-MLS和MI-MLS后分别有4例（21%）和13例（36%）患者需要进行后续手术。
本研究表明，对于双侧痉挛型CP患儿，C-MLS和MI-MLS术后24个月时，步态运动学和步行速度的改善相似。引用本文：2021;103-B(1):192-197。
