Lennon Nancy, Church Chris, Wagner Daniel, Niiler Tim, Henley John, Miller Freeman, Shrader Michael Wade, Howard Jason J
Department of Orthopaedics, Nemours Children's Health, Wilmington, DE 19803, USA.
Children (Basel). 2024 Oct 15;11(10):1240. doi: 10.3390/children11101240.
Abnormal gait kinematics are common in youth with cerebral palsy (CP), but prior studies have not analyzed their longitudinal change throughout childhood. This study examines how age and orthopaedic surgery influence gait kinematics throughout childhood in those with ambulatory CP.
In this institutional review board-approved prospective cohort study, children with spastic CP (GMFCS I-III) were recruited at age 17-40 months. Instrumented gait analysis was performed at 3-year intervals from age 4 to 21 years, collecting longitudinal kinematic data in bare feet at a self-selected speed. The change in Gait Profile Score (ΔGPS) between each pair of gait analyses (intervals) was analyzed by age distribution (<10, 10-15, ≥15 years) and by presence/absence of orthopaedic surgery.
The study included 31 children (GMFCS: I [13], II [14], III [4]). A baseline instrumented gait analysis was performed at age 5.8 ± 1.6 years with subsequent analysis at 2.5 ± 1.3-year intervals. Examining ΔGPS from baseline to final outcome, 87% of limbs were improved/unchanged; 298 intervals of ΔGPS were analyzed and classified as nonsurgical or surgical. Analysis revealed greater GPS improvement in intervals with surgery versus intervals without ( = 0.0004). Surgical intervals had significantly greater GPS improvement in the <10- vs. >15-year-old groups, = 0.0063.
Improvement in gait kinematics in children with CP is significantly influenced by age and timing of orthopaedic surgical intervention for gait correction, and was most pronounced for children <10 years old. Although surgery was associated with improved outcomes in all age groups, these improvements were significantly less for children >10 years old. These results reinforce the importance of considering the timing of orthopaedic surgery.
异常步态运动学在患有脑瘫（CP）的青少年中很常见，但先前的研究尚未分析其在整个儿童期的纵向变化。本研究探讨年龄和骨科手术如何影响非卧床型CP患儿在整个儿童期的步态运动学。
在这项经机构审查委员会批准的前瞻性队列研究中，招募了17 - 40个月大的痉挛型CP患儿（GMFCS I - III级）。从4岁到21岁，每隔3年进行一次仪器化步态分析，以自选速度收集赤脚状态下的纵向运动学数据。通过年龄分布（<10岁、10 - 15岁、≥15岁）以及是否进行骨科手术，分析每对步态分析（间隔期）之间的步态轮廓评分变化（ΔGPS）。
该研究纳入了31名儿童（GMFCS：I级[13名]、II级[14名]、III级[4名]）。在5.8±1.6岁时进行了基线仪器化步态分析，随后每隔2.5±1.3年进行一次分析。从基线到最终结果检查ΔGPS，87%的肢体得到改善/未改变；对298个ΔGPS间隔期进行了分析，并分为非手术期或手术期。分析显示，与非手术间隔期相比，手术间隔期的GPS改善更大（P = 0.0004）。手术间隔期在<10岁组与>15岁组中，GPS改善显著更大，P = 0.0063。
CP患儿步态运动学的改善受到年龄和用于步态矫正的骨科手术干预时机的显著影响，对于<10岁的儿童最为明显。虽然手术在所有年龄组中都与更好的结果相关，但对于>10岁的儿童，这些改善明显较少。这些结果强化了考虑骨科手术时机的重要性。
