Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
J Pediatr Orthop. 2021 Sep 1;41(8):520-524. doi: 10.1097/BPO.0000000000001886.
Children with cerebral palsy (CP) often present with a stiff knee gait pattern because of rectus femoris (RF) spasticity and/or contracture. Rectus femoris transfers (RFTs) and resections are surgical procedures aimed at reducing muscle stiffness, thereby improving knee flexion during the swing phase of gait. Previous research has consistently demonstrated objective benefits of rectus transfer using instrumented gait analysis (IGA). Rectus femoris resection (RFR), a relatively simpler procedure, shows similar improvement in knee range of motion during gait. The objective of this study was to compare surgical outcomes between rectus transfers and resections using 3-dimensional IGA.
Children with spastic CP who had RFTs or resections were retrospectively matched by walking speed and preoperative knee kinematics from 3-dimensional IGA (peak and timing of peak knee flexion in swing). Secondary outcomes included knee range of motion and maximum knee extension during gait.
Twenty-eight children were included in both the transfer group [age 9.4±2 y; Gross Motor Function Classification System (GMFCS) I (3 children), II (15 children), III (8 children), and IV (2 children)] and the resection group [age 10.6±2.5 y; GMFCS I (1 child), II (14 children), and III (13 children)]. Both surgical groups showed statistically significant short-term postsurgical improvements in peak knee flexion during swing (P<0.001 for the transfer group and P=0.003 for the resection group) and Duncan-Ely test (P=0.004 for the transfer group and P<0.001 for the resection group). Further analysis by GMFCS level showed children at GMFCS levels III/IV had a greater tendency to crouch after RFT when compared with children at GMFCS levels I/II. This tendency was not observed in the RFR group.
Both transfer and resection surgeries significantly improved gait kinematics short-term outcomes in children with spastic CP who present with stiff knee gait pattern. Further studies are required to compare long-term outcomes of both surgeries.
Level III-retrospective matched-cohort study.
脑瘫儿童由于股直肌痉挛和/或挛缩，常呈现僵硬的膝关节步态模式。股直肌转移（RFT）和切除术是旨在降低肌肉僵硬度的手术程序，从而改善步态摆动相时的膝关节屈曲。先前的研究一致表明，使用仪器步态分析（IGA）进行股直肌转移具有客观的益处。相对简单的股直肌切除术（RFR）显示在步态中膝关节活动度有类似的改善。本研究的目的是使用三维 IGA 比较股直肌转移与切除术的手术结果。
回顾性匹配了接受 RFT 或切除术的痉挛性脑瘫儿童，匹配的标准为 3 维 IGA 的步行速度和术前膝关节运动学（摆动时的峰值和峰值时间）（膝关节峰值屈曲和摆动时的峰值时间）。次要结果包括步态时的膝关节活动范围和最大膝关节伸展度。
28 名儿童分别纳入转移组（年龄 9.4±2 岁；粗大运动功能分级系统（GMFCS）I（3 例）、II（15 例）、III（8 例）和 IV（2 例））和切除术组（年龄 10.6±2.5 岁；GMFCS I（1 例）、II（14 例）和 III（13 例））。两组手术均显示短期术后摆动时膝关节最大屈曲（转移组 P<0.001，切除术组 P=0.003）和 Duncan-Ely 测试（转移组 P=0.004，切除术组 P<0.001）的统计学显著改善。按 GMFCS 水平进一步分析显示，与 GMFCS 水平 I/II 的儿童相比，GMFCS 水平 III/IV 的儿童在接受 RFT 后更倾向于出现蹲伏。这种趋势在 RFR 组中没有观察到。
股直肌转移和切除术均可显著改善僵硬膝关节步态模式脑瘫儿童的步态运动学短期结果。需要进一步的研究来比较两种手术的长期结果。
III 级-回顾性匹配队列研究。
