Daly C, McKeating H, Kiernan D
Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
Gait Posture. 2022 Jun;95:141-148. doi: 10.1016/j.gaitpost.2022.04.018. Epub 2022 Apr 25.
Age related progression needs to be considered when assessing current status and treatment outcomes in cerebral palsy (CP).
What is the association between age, gait kinematics and clinical measures in children with bilateral CP?
A retrospective database review was conducted. Subjects with bilateral CP with baseline and follow-up 3D gait analyses, but no history of intervening surgery were identified. Clinical and summary kinematic measures were examined for age related change using repeat measures correlation. Interactions with GMFCS classification and whether surgery was recommended were examined using robust linear regression. Timeseries kinematic data for baseline and most recent follow-up analyses were analysed using statistical parametric mapping.
180 subjects were included. 75% of participants were classified as GMFCS I or II at baseline. Mean time to follow-up was 4.89 (2.8) years (range 1-15.9 years) with a mean age of 6.4 (2.4) at baseline and 11.3 (3.4) at final follow-up. 15.5% of subjects demonstrated an improvement in GMFCS classification while GDI remained stable. Age related progression was noted across many clinical measures with moderate correlations (r ≥ 0.5) noted for reduced popliteal angle, long lever hip abduction and internal hip rotation range. In gait, there was reduced hip extension in late stance (p < 0.001), increased knee flexion in mid-stance (p < 0.001), reduced peak knee flexion in swing (p < 0.001) and increased ankle dorsiflexion in stance (p < 0.001). In the coronal plane, there was reduced hip abduction in swing (p < 0.001). In the transverse plane, increased external rotation of the knee (p < 0.001) and reduced external ankle rotation were noted in early stance and through swing (p < 0.001). There were no changes in foot progression or hip rotation.
Individuals with CP show age related progression of clinical and kinematic variables. Treatment can only be deemed successful if outcomes exceed or match these age-related changes.
在评估脑瘫（CP）的当前状况和治疗效果时，需要考虑与年龄相关的病情进展。
双侧脑瘫患儿的年龄、步态运动学与临床指标之间有何关联？
进行了一项回顾性数据库分析。纳入了具有基线和随访3D步态分析数据、但无手术干预史的双侧脑瘫受试者。使用重复测量相关性分析临床和运动学综合指标与年龄相关的变化。使用稳健线性回归分析与GMFCS分类以及是否建议手术的相互作用。对基线和最近一次随访分析的时间序列运动学数据进行统计参数映射分析。
共纳入180名受试者。75%的参与者在基线时被分类为GMFCS I或II级。平均随访时间为4.89（2.8）年（范围1 - 15.9年），基线时平均年龄为6.4（2.4）岁，末次随访时为11.3（3.4）岁。15.5%的受试者GMFCS分级有所改善，而GDI保持稳定。在许多临床指标中都观察到了与年龄相关的进展，腘角减小、长杠杆髋关节外展和髋关节内旋范围减小呈现中度相关性（r≥0.5）。在步态方面，支撑后期髋关节伸展减少（p < 0.001），支撑中期膝关节屈曲增加（p < 0.001），摆动期膝关节屈曲峰值降低（p < 0.001），支撑期踝关节背屈增加（p < 0.001）。在冠状面，摆动期髋关节外展减少（p < 0.001）。在横断面，膝关节在支撑早期和整个摆动期外旋增加（p < 0.001），踝关节外旋减少（p < 0.001）。足部前进或髋关节旋转无变化。
脑瘫患者的临床和运动学变量呈现与年龄相关的进展。只有当治疗结果超过或匹配这些与年龄相关的变化时，才能认为治疗是成功的。
