Gait Laboratory, Central Remedial Clinic, Vernon Ave, Dublin 3, Ireland.
Gait Posture. 2021 Sep;89:126-131. doi: 10.1016/j.gaitpost.2021.07.007. Epub 2021 Jul 16.
Increased terminal swing knee flexion (TSKF) impacts on step length, walking efficiency and may lead to knee flexion in stance in cerebral palsy (CP). Surgical lengthening of the hamstrings is often used to address this issue, but outcomes are inconsistent. There is an established association between TSKF and functional shortening or reduced lengthening velocity of the hamstrings. However, the aetiology of increased TSKF in CP is complex and additional associated factors are not well understood. An examination of clinical and kinematic factors associated with increased TSKF may demonstrate this complexity, highlight the multifactorial nature of this feature and provide a basis for enhanced treatment decision making.
What kinematic and clinical factors are associated with TSKF in individuals with CP?.
A retrospective database review was conducted. Individuals with bilateral CP were identified and a subset was extracted which represented the full spectrum of degree of TSKF in the database. The total dataset for analysis was n = 88. Associations between absolute clinical and kinematic data and TSKF were explored using correlation analysis, linear and multivariate regression. Time series data were examined across quartiles using statistical parametric mapping analysis of variance (SPM ANOVA).
Increased TSKF was associated with overall gait impairment (GDI), degree of knee flexion throughout the stride, knee extension velocity, hamstring lengthening characteristics and functional status (GMFCS). There was no relationship to walking speed or clinical measures of hamstring extensibility on clinical assessment.
TSKF is associated with multiple factors which clinicians need to consider when devising treatment strategies. Caution is advised when relying on degree of TSKF to independently guide surgical decision-making.
末端摆动膝关节屈曲（TSKF）增加会影响步长和步行效率，并可能导致脑瘫（CP）中的站立时膝关节屈曲。通常使用腘绳肌延长术来解决这个问题，但结果不一致。TSKF 与腘绳肌的功能缩短或延长速度降低之间存在既定的关联。然而，CP 中 TSKF 增加的病因复杂，其他相关因素也不明确。检查与 TSKF 增加相关的临床和运动学因素可以说明这种复杂性，突出该特征的多因素性质，并为增强治疗决策提供依据。
与 CP 患者 TSKF 相关的运动学和临床因素有哪些？
进行了回顾性数据库研究。确定了双侧 CP 患者，并从中提取了一个子集，该子集代表了数据库中 TSKF 程度的全貌。分析的总数据集为 n = 88。使用相关分析、线性和多元回归探索了 TSKF 与绝对临床和运动学数据之间的关联。使用方差分析的统计参数映射分析（SPM ANOVA）检查了时间序列数据在四分位数之间的关系。
增加的 TSKF 与整体步态障碍指数（GDI）、整个步幅中的膝关节屈曲程度、膝关节伸展速度、腘绳肌延长特征和功能状态（GMFCS）相关。与步行速度或临床评估中腘绳肌伸展性的临床测量值无关。
TSKF 与多个因素相关，临床医生在制定治疗策略时需要考虑这些因素。在依赖 TSKF 程度来独立指导手术决策时需要谨慎。
