Widmer Michèle, Staganello Monica, Sangeux Morgan, Odorizzi Marco, Brunner Reinald, Viehweger Elke
Neuroorthopaedics and Motion Analysis Unit, Department of Orthopaedics, University Children's Hospital Basel, Basel, Switzerland.
J Child Orthop. 2024 Apr 29;18(4):441-449. doi: 10.1177/18632521241244624. eCollection 2024 Aug.
Tibialis anterior tendon shortening combined with tendon Achilles lengthening showed satisfactory short- and long-term outcomes for pes equinus treatment. This retrospective study aimed to evaluate the effectiveness of a single tibialis anterior tendon shortening-tendon Achilles lengthening procedure for treating pes equinus, in a homogeneous unilateral cerebral palsy patient group.
Gait analysis was conducted on 22 unilateral cerebral palsy patients (mean age at surgery = 13.3 years, standard deviation = 3 years) before and within 2.5 years (standard deviation = 0.61 years) after the tibialis anterior tendon shortening-tendon Achilles lengthening procedure. Primary outcome measures included foot drop occurrence in swing, foot dorsiflexion and the first ankle rocker presence compared to healthy reference data. Movement analysis profile and gait profile score were also calculated for the entire gait cycle. The clinical exam and the A2 peak ankle power were analyzed. Statistical analysis used the paired Wilcoxon's sign rank test (p < 0.05).
Post-operatively, significant improvements were observed in ankle dorsiflexion during swing (p = 0.0006) and reduced foot drop in swing (p = 0.0107). The occurrence of a first ankle rocker did not significantly change (p = 0.1489). Significant improvements in gait profile score and movement analysis profile for all joints and planes indicate overall gait quality improvement. The foot progression changed significantly (p = 0.0285), with a greater external orientation. Nineteen out of 22 patients were able to quit wearing their ankle foot orthoses.
Tibialis anterior tendon shortening and tendon Achilles lengthening combination yielded positive outcomes, showing increased foot dorsiflexion, first ankle rocker presence, and overall improved gait quality. These findings support the effectiveness of this surgical approach for treating pes equinus in children with unilateral spastic cerebral palsy.
胫骨前肌腱缩短联合跟腱延长术在马蹄足治疗中显示出令人满意的短期和长期效果。本回顾性研究旨在评估在一组同质的单侧脑瘫患者中，单一的胫骨前肌腱缩短 - 跟腱延长手术治疗马蹄足的有效性。
对22例单侧脑瘫患者（手术时平均年龄 = 13.3岁，标准差 = 3岁）在胫骨前肌腱缩短 - 跟腱延长手术后2.5年内（标准差 = 0.61年）及术前进行步态分析。主要结局指标包括摆动期足下垂的发生情况、足背屈以及与健康对照数据相比首次出现的踝关节摆动相。还计算了整个步态周期的运动分析概况和步态概况评分。分析了临床检查和A2峰值踝关节功率。统计分析采用配对Wilcoxon符号秩检验（p < 0.05）。
术后，摆动期踝关节背屈有显著改善（p = 0.0006），摆动期足下垂减少（p = 0.0107）。首次出现踝关节摆动相没有显著变化（p = 0.1489）。所有关节和平面的步态概况评分和运动分析概况均有显著改善，表明整体步态质量提高。足部前进方向有显著变化（p = 0.0285），外翻角度增大。22例患者中有19例能够停止佩戴踝足矫形器。
胫骨前肌腱缩短与跟腱延长联合手术产生了积极的效果，表现为足背屈增加、首次出现踝关节摆动相以及整体步态质量改善。这些发现支持了这种手术方法治疗单侧痉挛性脑瘫患儿马蹄足的有效性。
