脑瘫儿童术后垂直地面反力、赤脚和踝足矫形器行走的变化。
Postoperative changes in vertical ground reaction forces, walking barefoot and with ankle-foot orthoses in children with Cerebral Palsy.
机构信息
Department for Child Neurology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
Division of Orthopaedic Surgery, Department of Research, Oslo University Hospital, Oslo, Norway; Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
出版信息
Clin Biomech (Bristol). 2021 Apr;84:105336. doi: 10.1016/j.clinbiomech.2021.105336. Epub 2021 Mar 23.
BACKGROUND
Children with cerebral palsy often have problems to support the body centre of mass, seen as increased ratio between excessive vertical ground reaction forces during weight acceptance and decreased forces below bodyweight in late stance. We aimed to examine whether increasing ankle range of motion through surgery and restraining motion with ankle-foot orthoses postoperatively would have impact on the vertical ground reaction force in weight acceptance and late stance.
METHODS
Ground reaction forces were recorded from 24 children with bilateral and 32 children with unilateral cerebral palsy, each measured walking barefoot before and after triceps surae lengthening. Postoperatively, the children were also measured walking with ankle-foot orthoses. Changes in vertical ground reaction forces between the three conditions were evaluated with functional curve and descriptive peak analyses; accounting for repeated measures and within-subject correlation.
FINDINGS
After surgery, there were decreased vertical ground reaction forces in weight acceptance and increased forces in late stance. Additional significant changes with ankle-foot orthoses involved increased vertical forces in weight acceptance, and in late stance corresponding to bodyweight (bilateral, from 92% to 98% bodyweight; unilateral, from 94% to 103% bodyweight) postoperatively.
INTERPRETATION
Our findings confirmed that surgery affected vertical ground reaction forces to approach more normative patterns. Additional changes with ankle-foot orthoses indicated further improved ability to support bodyweight and decelerate centre of mass in late stance.
背景
脑瘫儿童常常难以支撑身体重心，表现在承重期垂直地面反作用力过大、后期支撑期低于体重的力减小。我们旨在研究通过手术增加踝关节活动范围并在术后使用踝足矫形器限制运动是否会影响承重期和后期支撑期的垂直地面反作用力。
方法
记录了 24 名双侧脑瘫儿童和 32 名单侧脑瘫儿童的地面反作用力，每位儿童在接受比目鱼肌延长术后分别进行了赤脚行走的术前和术后测量。术后，还对儿童使用踝足矫形器行走进行了测量。使用功能曲线和描述性峰值分析评估三种情况下垂直地面反作用力的变化；考虑到重复测量和个体内相关性。
结果
手术后，承重期垂直地面反作用力减小，后期支撑期垂直地面反作用力增加。踝足矫形器的附加显著变化包括承重期垂直力增加，以及后期支撑期对应体重的力增加（双侧，从 92%体重增加到 98%体重；单侧，从 94%体重增加到 103%体重）。
结论
我们的发现证实手术影响垂直地面反作用力，使其更接近正常模式。踝足矫形器的附加变化表明进一步提高了支撑体重和在后期支撑期减速身体重心的能力。
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