Pierz Kristan, Brimacombe Michael, Õunpuu Sylvia
Center for Motion Analysis, Division of Orthopedics, Connecticut Children's Medical Center, United States; Orthopedic Surgery, University of Connecticut School of Medicine, United States.
Research Department, Connecticut Children's Medical Center, United States.
Gait Posture. 2022 Jan;91:318-325. doi: 10.1016/j.gaitpost.2021.10.035. Epub 2021 Oct 29.
Increased knee flexion at initial contact and in stance is a common problem for children with cerebral palsy. Surgical correction with percutaneous hamstring lengthening is an alternative to open hamstring lengthening; however, outcomes are less well documented, and there is concern about increasing anterior pelvic tilt. The purpose of this study was to evaluate the short-term outcomes of percutaneous hamstring lengthenings in children with cerebral palsy using comprehensive gait analysis techniques.
Does percutaneous hamstring lengthening improve knee function, and do knee and anterior pelvic tilt outcomes vary by GMFCS level?
A convenience sample of 52 patients with both pre and post-surgical gait analyses was evaluated retrospectively for changes in gait function in terms of temporal-spatial parameters, kinematics and kinetics. Patients were divided into two GMFCS subgroups: GMFCS level I/II and III.
The percutaneous hamstring lengthening results in statistically significant improvements in knee function during gait with increased knee extension at initial contact (mean 32° SD 13° to mean 21° SD 11°, p = 0.000) and improved mean knee flexion in stance (mean 23° SD 12° to mean 16° SD 11°, p = 0.000) for the total study cohort. Beneficial changes were found for knee function in both GMFCS level subgroups; however, there was an increase in pelvic tilt pre to post-surgery in the GMFCS level III subgroup (mean 21° SD 8° to mean 26° SD 6°, p = 0.012) but not the GMFCS level I/II subgroup (mean 18° SD 7° to mean 20° SD 8°, p = 0.427).
Percutaneous hamstring lengthening can improve knee function for all patients; however, the impact on anterior pelvic tilt varies by GMFCS level, with increasing anterior tilt for GMFCS level III only. This study highlights the importance of understanding differences in surgical outcomes by GMFCS level to better predict post-surgical function.
脑瘫患儿在初次接触和站立时膝关节屈曲增加是一个常见问题。经皮腘绳肌延长术是开放性腘绳肌延长术的一种替代方法；然而，其结果记录较少，且人们担心会增加骨盆前倾。本研究的目的是使用综合步态分析技术评估脑瘫患儿经皮腘绳肌延长术的短期效果。
经皮腘绳肌延长术是否能改善膝关节功能，膝关节和骨盆前倾的结果是否因 Gross Motor Function Classification System（GMFCS）水平而异？
对52例术前和术后均进行步态分析的患者进行便利抽样，回顾性评估其在时空参数、运动学和动力学方面的步态功能变化。患者被分为两个GMFCS亚组：GMFCS I/II级和III级。
对于整个研究队列，经皮腘绳肌延长术使步态期间膝关节功能有统计学意义的改善，初次接触时膝关节伸展增加（平均32°标准差13°至平均21°标准差11°，p = 0.000），站立时平均膝关节屈曲改善（平均23°标准差12°至平均16°标准差11°，p = 0.000）。在两个GMFCS水平亚组中均发现膝关节功能有有益变化；然而，GMFCS III级亚组术后骨盆前倾增加（平均21°标准差8°至平均26°标准差6°，p = 0.012），而GMFCS I/II级亚组未增加（平均18°标准差7°至平均20°标准差8°，p = 0.427）。
经皮腘绳肌延长术可改善所有患者的膝关节功能；然而，对骨盆前倾的影响因GMFCS水平而异，仅GMFCS III级会增加骨盆前倾。本研究强调了了解GMFCS水平对手术结果的差异以更好预测术后功能的重要性。
