Hanson Alison M, Nadeau Jason T, Ciccodicola Eva M, Rethlefsen Susan A, Wren Tishya A L, Kay Robert M
Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles.
Keck School of Medicine, University of Southern California, Los Angeles, CA.
J Pediatr Orthop. 2025 Aug 1;45(7):416-422. doi: 10.1097/BPO.0000000000002973. Epub 2025 Apr 4.
Single event multi-level surgery (SEMLS) is the standard of orthopaedic care for children with cerebral palsy (CP). The optimal age to perform SEMLS is unclear, with studies showing positive results from childhood to adulthood. Few studies have combined clinical gait analysis with participation and activity outcome measures. The purpose of this study was to examine the effect of age on changes in gait parameters, activity, and participation in children with CP who underwent SEMLS with a follow-up time of 8 to 48 months.
One hundred twenty-eight participants met the inclusion criteria. Ninety-one participants (71%) were aged under 11 years and 37 participants (29%) were 11 years or older. Changes in gait deviation index (GDI), walking velocity, stride length, functional mobility scale (FMS), and pediatric outcomes data collection instrument (PODCI) scores were calculated. The impact of age on outcomes was analyzed in age groups (<11 vs. ≥11 y) using linear and ordered logistic regression. The Gross Motor Function Classification System level was included as a covariate in all analyses.
There was no difference between age groups for preoperative to postoperative change in GDI, walking velocity, or FMS. The younger group significantly improved GDI, stride length, and global and upper extremity PODCI scores after SEMLS, while the older group significantly improved GDI only. The PODCI upper extremity subscale was the only variable impacted by age group ( P =0.02).
Children with CP who undergo SEMLS at any age are likely to see improvements in the GDI. Those under 11 years at the time of SEMLS also show improvements in stride length and global and upper extremity PODCI scores, while those older than 11 years are likely to maintain but not improve their levels of activity and participation.
Level III-retrospective comparative study.
单事件多级手术（SEMLS）是脑瘫（CP）患儿骨科治疗的标准方法。进行SEMLS的最佳年龄尚不清楚，研究表明从儿童期到成年期都有积极的结果。很少有研究将临床步态分析与参与度和活动结果测量相结合。本研究的目的是探讨年龄对接受SEMLS且随访时间为8至48个月的CP患儿步态参数、活动和参与度变化的影响。
128名参与者符合纳入标准。91名参与者（71%）年龄在11岁以下，37名参与者（29%）年龄在11岁及以上。计算步态偏差指数（GDI）、步行速度、步长、功能移动量表（FMS）和儿科结局数据收集工具（PODCI）评分的变化。使用线性和有序逻辑回归分析年龄组（<11岁与≥11岁）对结局的影响。在所有分析中，将粗大运动功能分类系统水平作为协变量纳入。
年龄组之间在术前至术后GDI、步行速度或FMS的变化方面没有差异。较年轻组在SEMLS后GDI、步长以及整体和上肢PODCI评分有显著改善，而较年长组仅GDI有显著改善。PODCI上肢子量表是受年龄组影响的唯一变量（P = 0.02）。
任何年龄接受SEMLS的CP患儿GDI都可能改善。SEMLS时年龄在11岁以下的患儿步长以及整体和上肢PODCI评分也有改善，而11岁以上的患儿可能维持但不会改善其活动和参与水平。
III级——回顾性比较研究。
