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脑性瘫痪马蹄足手术矫正对步态模式的影响

The Impact of Operative Correction of Equinus in Cerebral Palsy on Gait Patterns.

作者信息

Horsch Axel, Petzinger Lara, Deisenhofer Julian, Ghandour Maher, Klotz Matthias, Renkawitz Tobias, Putz Cornelia

机构信息

Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany.

Orthopedics and Trauma Surgery, Marienkrankenhaus Soest, Soest, Germany.

出版信息

Foot Ankle Int. 2024 Feb;45(2):130-140. doi: 10.1177/10711007231217273. Epub 2023 Dec 29.

Abstract

BACKGROUND

This study aimed to evaluate gait outcomes and strength following the surgical correction of equinus in cerebral palsy (CP) based on different surgical procedures. We included the Baumann and Strayer procedures, as well as the Achilles tendon lengthening (ATL).

METHODS

A retrospective analysis was performed in patients with infantile, bilateral CP who received instrumental 3D gait analysis before and after surgical correction (18.66 months postoperatively). Patients were divided into 3 groups: Strayer surgery, Baumann surgery, and ATL. Gait performance and muscle strengths were compared between studied surgeries.

RESULTS

A total population of 204 patients (15.43 years) with 341 operated lower limbs (LLs) was analyzed. Dorsiflexion in swing and stance phases significantly improved in all groups postoperatively. The Strayer and the ATL group showed higher postoperative dorsiflexion than the Baumann group. However, no loss of strength was observed with the Baumann method. Maximum power improved in this group postoperatively. An 8.2% loss in calf muscle strength was recorded in the Strayer group.

CONCLUSION

Operative pes equinus treatment successfully improved the gait of children and adults with CP postoperatively. There were differences in postoperative results between studied operative techniques regarding range of motion and power.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

摘要

背景

本研究旨在评估基于不同手术方法对脑瘫(CP)马蹄足进行手术矫正后的步态结果和肌力。我们纳入了鲍曼手术和斯特雷耶手术,以及跟腱延长术(ATL)。

方法

对接受手术矫正前后(术后18.66个月)进行仪器化三维步态分析的婴幼儿双侧CP患者进行回顾性分析。患者分为3组:斯特雷耶手术组、鲍曼手术组和跟腱延长术组。比较各研究手术之间的步态表现和肌肉力量。

结果

分析了204例患者(15.43岁)共341条接受手术的下肢(LLs)。术后所有组在摆动期和站立期的背屈均显著改善。斯特雷耶手术组和跟腱延长术组术后背屈高于鲍曼手术组。然而,鲍曼手术方法未观察到肌力丧失。该组术后最大功率有所改善。斯特雷耶手术组小腿肌肉力量记录有8.2%的损失。

结论

马蹄足手术治疗成功改善了CP儿童和成人术后的步态。各研究手术技术在术后活动范围和功率方面的结果存在差异。

证据水平

III级,回顾性队列研究。

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