Papageorgiou Eirini, Everaert Laure, Molenaers Guy, Ortibus Els, Desloovere Kaat, Van Campenhout Anja
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
Dev Med Child Neurol. 2025 Jun;67(6):802-811. doi: 10.1111/dmcn.16160. Epub 2024 Nov 28.
To identify the short-term effects of selective dorsal rhizotomy (SDR) on gait and clinical impairments in children with bilateral spastic cerebral palsy (CP) and subgroups based on baseline gait patterns.
Eighty-nine children with bilateral spastic CP (55 males, mean age [SD] before SDR: 9 years 5 months [2 years 3 months]; Gross Motor Function Classification System level I: 18; II: 54; III: 17) received three-dimensional gait analyses at two time points (baseline and 1 year after SDR); their baseline gait patterns were classified. The analysis included the comparisons of (1) sagittal plane kinematic waveforms, the Gait Profile Score, and non-dimensional spatiotemporal parameters between the two time points, (2) the kinematic waveforms of both time points to those of typically developing children, and (3) composite impairment scores of spasticity, weakness, and selectivity between the two time points.
Overall, kinematics improved distally but deteriorated proximally in the entire sample, especially in genu recurvatum and crouch gait patterns. Jump gait showed the most improvements after SDR, followed by apparent equinus and crouch gait. Spasticity was reduced after SDR, but not at the expense of strength or selectivity.
The potential merit of investigating short-term SDR effects on gait according to baseline gait patterns was shown, with an overview of changes after SDR that may facilitate patient-tailored treatment.
确定选择性背根切断术（SDR）对双侧痉挛性脑瘫（CP）患儿步态及临床损伤的短期影响，并根据基线步态模式对亚组进行分析。
89例双侧痉挛性CP患儿（55例男性，SDR术前平均年龄[标准差]：9岁5个月[2岁3个月]；粗大运动功能分类系统I级：18例；II级：54例；III级：17例）在两个时间点（基线和SDR术后1年）接受三维步态分析；对其基线步态模式进行分类。分析内容包括：（1）两个时间点之间矢状面运动学波形、步态轮廓评分和无量纲时空参数的比较；（2）两个时间点的运动学波形与正常发育儿童的运动学波形的比较；（3）两个时间点之间痉挛、肌力减弱和选择性的综合损伤评分的比较。
总体而言，整个样本的运动学在远端有所改善，但在近端有所恶化，尤其是在膝反张和蹲伏步态模式中。跳跃步态在SDR术后改善最为明显，其次是明显的马蹄足和蹲伏步态。SDR术后痉挛程度减轻，但并未以牺牲肌力或选择性为代价。
研究显示了根据基线步态模式调查SDR对步态短期影响的潜在价值，并概述了SDR术后的变化，这可能有助于制定个性化的患者治疗方案。
