Pandey Ritesh Arvind, Johari Ashok N, Shetty Triveni
Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Phulwari Sharif, Aurangabad Road, Patna, Bihar 801507 India.
Children's Orthopaedic Centre, 2nd Floor, Bobby Apartments, 143 L.J. Road, Mahim (West), Mumbai, 400016 India.
Indian J Orthop. 2023 Sep 30;57(12):1913-1926. doi: 10.1007/s43465-023-01002-5. eCollection 2023 Dec.
Crouch gait is the most common pathological gait pattern in cerebral palsy and is commonly seen in patients with spastic diplegia. It is characterized by excessive knee flexion throughout the stance phase of gait cycle. The aim of this review is to discuss the current literature about CG for a more comprehensive understanding.
A literature review about various aspects of crouch gait in cerebral palsy was undertaken. This included its etiology and pathophysiology, biomechanics in crouch gait, natural history of untreated crouch gait, clinical and radiological evaluation and different modalities of available treatment.
The etiology is multifactorial and the pathophysiology is poorly understood. This makes its management challenging, thereby leading to a variety of available treatment modalities. Inadvertent lengthening of muscle-tendon units is an important cause and can be avoided. A meticulous clinical and radiological evaluation of patients, supplemented by observational and instrumented gait analysis is mandatory in choosing correct treatment modality and improving the treatment outcome. Younger children can be managed satisfactorily by various non-operative methods and spasticity reduction measures. However, crouch gait in cerebral palsy has a progressive natural history and surgical interventions are needed frequently. The current literature supports combination of various soft tissue and bony procedures as a part of single event multilevel surgery. Growth modulation in the form of anterior distal femur hemiepiphysiodesis for correction of fixed flexion deformity of knee has shown encouraging results and can be an alternative in younger children with sufficient growth remaining.
In spite of extensive research in this field, the current understanding about crouch gait has many knowledge gaps. Further studies about the etiopathogenesis and biomechanics of crouch using instrumented gait analysis are suggested. Similarly, future research should focus on the long term outcomes of different treatment modalities through comparative trials.
蹲伏步态是脑瘫最常见的病理性步态模式，常见于痉挛性双侧瘫患者。其特征是在步态周期的支撑期整个过程中膝关节过度屈曲。本综述的目的是讨论有关蹲伏步态的当前文献，以获得更全面的理解。
对脑瘫患者蹲伏步态的各个方面进行了文献综述。这包括其病因和病理生理学、蹲伏步态的生物力学、未经治疗的蹲伏步态的自然病史、临床和放射学评估以及可用的不同治疗方式。
病因是多因素的，病理生理学尚不清楚。这使得其管理具有挑战性，从而导致了多种可用的治疗方式。肌腱单位的意外延长是一个重要原因，可以避免。在选择正确的治疗方式和改善治疗结果时，必须对患者进行细致的临床和放射学评估，并辅以观察性和仪器化步态分析。年幼的儿童可以通过各种非手术方法和降低痉挛措施得到满意的治疗。然而，脑瘫中的蹲伏步态具有渐进性的自然病史，经常需要手术干预。当前文献支持将各种软组织和骨手术联合作为单阶段多水平手术的一部分。以股骨远端前半骨骺阻滞术形式进行的生长调节用于矫正膝关节固定屈曲畸形已显示出令人鼓舞的结果，对于仍有足够生长潜力的年幼儿童可以作为一种选择。
尽管在该领域进行了广泛研究，但目前对蹲伏步态的理解仍存在许多知识空白。建议使用仪器化步态分析对蹲伏步态的病因发病机制和生物力学进行进一步研究。同样，未来的研究应通过比较试验关注不同治疗方式的长期结果。
