Bonnefoy-Mazure Alice, De Coulon Geraldo, Lascombes Pierre, Bregou Aline, Armand Stéphane
Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Pediatric Orthopedic Service, Department of Child and Teenage Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
J Child Orthop. 2023 Mar 6;17(2):173-183. doi: 10.1177/18632521231154975. eCollection 2023 Apr.
The purpose of this study was to describe gait evolution in patients with unilateral spastic cerebral palsy (USCP) using modified Gait Profile Score (mGPS without hip rotation), Gait Variable Score (GVS), walking speed, and the observed effects of single-level surgery (SLS) after 10 years.
Fifty-two patients with USCP (Gross Motor Function Classification System I) and data from two Clinical Gait Analyses (CGAs) were included. The evolution of patients' mGPS, GVS, and walking speed were calculated. Two "no surgery" and "single-level surgery" patient categories were analyzed. Paired -tests were used to compare the data between CGAs and as a function of treatment category. Pearson's correlations were used to examine relationships between baseline values and evolutions in mGPS and walking speed.
Mean ages (SD) at first and last CGAs were 9.3 (3.2) and 19.7 (6.0) years old, respectively, with an average follow-up of 10.5 (5.6) years. Mean mGPS for the patients' affected side was significantly lower at the last CGA for the full cohort: baseline = 8.5° (2.1) versus follow-up = 7.2° (1.6), effect size = 0.73, < 0.001. Significant improvements in mGPS and GVS for ankle and foot progression were found for the SLS group. The mGPS change and mGPS at baseline (r = -0.79, < 0.001) were negatively correlated.
SLS patients demonstrated a positive long-term change in gait pattern over time. The group that had undergone surgery had worse gait scores at baseline than the group that had not, but the SLS group's last CGA scores were relatively closer to those of the "no surgery" group.
This was a retrospective comparative therapeutic study (level III).
本研究旨在使用改良步态轮廓评分（不包括髋关节旋转的mGPS）、步态变量评分（GVS）、步行速度以及观察单节段手术（SLS）10年后的效果，来描述单侧痉挛性脑瘫（USCP）患者的步态演变情况。
纳入52例USCP患者（粗大运动功能分类系统I级）以及来自两次临床步态分析（CGA）的数据。计算患者mGPS、GVS和步行速度的演变情况。分析两个“未手术”和“单节段手术”患者类别。配对检验用于比较CGA之间的数据以及作为治疗类别的函数。Pearson相关性用于检验mGPS和步行速度的基线值与演变之间的关系。
首次和末次CGA时的平均年龄（标准差）分别为9.3（3.2）岁和19.7（6.0）岁，平均随访时间为10.5（5.6）年。在末次CGA时，全队列患者患侧的平均mGPS显著降低：基线时为8.5°（2.1），随访时为7.2°（1.6），效应量为0.73，P<0.001。SLS组在踝关节和足部进展的mGPS和GVS方面有显著改善。mGPS变化与基线时的mGPS（r=-0.79，P<0.001）呈负相关。
随着时间推移，SLS患者的步态模式显示出积极的长期变化。接受手术的组在基线时的步态评分比未接受手术的组差，但SLS组的末次CGA评分相对更接近“未手术”组。
这是一项回顾性比较治疗研究（III级）。
