Gage J R
Gilette Children's Hospital, St. Paul, MN 55101.
Clin Orthop Relat Res. 1993 Mar(288):126-34.
Gait analysis has radically changed the treatment of cerebral palsy. Preoperatively, it allows critical assessment of the specific pathologies of the patient. Postoperatively, it provides an accurate assessment of outcome. This assessment of outcome has in turn allowed the accurate critique of surgeries and has made it possible to discard treatments that are not useful or are perhaps even injurious. As a result of this continual reassessment of surgical techniques, several principles and insights regarding the treatment of cerebral palsy have been learned. These include (1) the importance of reestablishing normal gait prerequisites, (2) the methods of reducing the energy expenditure of the pathologic gait, (3) the importance of skeletal structures in providing the lever arm by which muscles produce moments around joints, (4) the role and importance of two joint muscles, and (5) the importance of separating abnormalities, which are emanating from the neurologic lesion, from secondary ("coping") responses. Through gait analysis, it has become apparent that diplegia and hemiplegia are noninclusive terms, each of which contain a variety of homogeneous patterns of gait. Eventually these patterns may be separated and identified and optimal treatment protocols for each pattern type developed.
步态分析已经彻底改变了脑瘫的治疗方式。术前，它能对患者的具体病理状况进行关键评估。术后，它能对治疗结果进行准确评估。这种对结果的评估反过来又能对手术进行准确的评判，并使得摒弃那些无用甚至可能有害的治疗方法成为可能。由于对手术技术的这种持续重新评估，人们已经学到了一些关于脑瘫治疗的原则和见解。这些包括：（1）重新建立正常步态前提条件的重要性；（2）降低病理性步态能量消耗的方法；（3）骨骼结构在提供肌肉围绕关节产生力矩的杠杆臂方面的重要性；（4）双关节肌肉的作用和重要性；（5）将源自神经病变的异常与继发性（“应对”）反应区分开来的重要性。通过步态分析，很明显双瘫和偏瘫是不具有包容性的术语，每个术语都包含多种同质的步态模式。最终，这些模式可能会被分离和识别，并为每种模式类型制定最佳治疗方案。
