Lindén Olof, Lauge-Pedersen Henrik, Hägglund Gunnar, Wagner Philippe
Department of Clinical Sciences, Lund University, Lund; Department of Orthopedics, Skane University Hospital, Lund, Sweden.
Center for Clinical Research, Uppsala University, Region Västmanland, Västerås, Sweden.
Acta Orthop. 2025 Apr 17;96:331-338. doi: 10.2340/17453674.2025.43387.
Outcome after gastrocsoleus lengthening in cerebral palsy (CP) is reported to be influenced by type of lengthening, age, CP subtype, and preoperative range of motion (ROM). We examined the development of ankle and knee ROM after 3 types of isolated gastrocsoleus lengthening.
This is a register-based longitudinal cohort study based on data from the Swedish Cerebral Palsy follow Up Program, of children born 2000-2011 who underwent isolated gastrocsoleus lengthening. ROM development was analyzed using mixed-effects modeling. Event limits were defined as ankle ROM ≤ 0° or ≥ 20° and knee extension deficit ≤ -10° and described in Kaplan-Meier curves and Cox regression analyses. The study protocol was published at clinicaltrials.gov.
184 children were included. The mean differences in ankle ROM 10 years postoperatively between open tendo Achilles lengthening (OTAL) and percutaneous tendo Achilles lengthening (PTAL) was -2.3° (95% confidence interval [CI] -7.4 to 2.7), and between gastrocnemius lengthening (GCL) and PTAL -4.4° (CI -10.4 to 1.5). The adjusted hazard ratio (aHR), adjusted for baseline ROM, Gross Motor Function Classification System level, and CP subtype, comparing ankle event rates between OTAL and PTAL was 2.5 (CI 1.1-5.7). GCL was also associated with a higher event rate compared with PTAL, aHR 2.0 (CI 0.85-4.6). The adjusted mean difference in knee ROM at 10 years between OTAL and PTAL was 5.1° (CI 0.4-9.8), and between GCL and PTAL 1.9° (CI -3.6 to 7.6). Comparing event rates for the knee yielded uncertain results.
PTAL appears at least as effective as OTAL and GCL for favorable ankle and knee ROM development in children with CP.
据报道，脑瘫（CP）患者行腓肠肌-比目鱼肌延长术后的结局受延长类型、年龄、CP亚型及术前活动度（ROM）的影响。我们研究了3种孤立性腓肠肌-比目鱼肌延长术后踝关节和膝关节ROM的变化情况。
这是一项基于登记的纵向队列研究，数据来自瑞典脑瘫随访项目，研究对象为2000年至2011年出生且接受孤立性腓肠肌-比目鱼肌延长术的儿童。使用混合效应模型分析ROM的变化情况。将事件界限定义为踝关节ROM≤0°或≥20°以及膝关节伸展不足≤-10°，并在Kaplan-Meier曲线和Cox回归分析中进行描述。该研究方案已在clinicaltrials.gov上公布。
共纳入184名儿童。术后10年，开放性跟腱延长术（OTAL）与经皮跟腱延长术（PTAL）之间踝关节ROM的平均差异为-2.3°（95%置信区间[CI]-7.4至2.7），腓肠肌延长术（GCL）与PTAL之间为-4.4°（CI-10.4至1.5）。在根据基线ROM、粗大运动功能分类系统水平和CP亚型进行调整后，比较OTAL与PTAL之间踝关节事件发生率的调整后风险比（aHR）为2.5（CI1.1-5.7）。与PTAL相比，GCL也与更高的事件发生率相关，aHR为2.0（CI0.85-4.6）。术后10年，OTAL与PTAL之间膝关节ROM的调整后平均差异为5.1°（CI0.4-9.8），GCL与PTAL之间为1.9°（CI-3.6至7.6）。比较膝关节的事件发生率得出的结果不确定。
对于CP患儿，PTAL在促进踝关节和膝关节良好的ROM发育方面至少与OTAL和GCL一样有效。
