Gait analysis before and after gastrocnemius fascia lengthening in children with cerebral palsy.
Gait analysis before and after gastrocnemius fascia lengthening in children with cerebral palsy.
复制标题
脑瘫患儿腓肠肌筋膜延长术前后步态分析
DOI：
10.5301/jabb.2008.1442
复制
发表时间：
2005
影响因子：
2.5
通讯作者：
G. Albertini
中科院分区：
文献类型：
--
作者：
Manuela Galli;V. Cimolin;M. Crivellini;G. Albertini
马蹄足畸形是痉挛型脑性瘫痪患儿的常见问题。持续畸形，干扰功能是通过手术延长小腿三头肌。手术入路存在马蹄足畸形或过度矫正的复发风险，伴随着跟骨畸形、蹲伏和步态期间蹬离力量减弱的发展。这些方面干扰腓肠肌/比目鱼肌复合体的基本功能。本研究旨在分析腓肠肌筋膜延长术对脑瘫患儿步态模式的运动学和动力学影响，特别是治疗前后蹬离能力的评价。对20例CP患儿行腓肠肌筋膜延长术（改良Vulpius技术）改善马蹄足和步行能力，术前、术后12个月进行临床检查和三维步态分析（GA）。结果显示，马蹄足显著减少，表现为初始接触（IC）时的角度（足部与地面在矢状面上的角度）减少，更接近健康儿童，并增加了蹬离过程中的踝关节发电。即使这一结果在统计学上没有显著性，但它也很重要，因为这意味着手术没有产生功能缺陷。动力学结果表明，改善（踝关节功率吸收和产生）与更多的功能性行走行为。一些关于膝关节的改善是显著的，特别是IC时的膝关节角度值和挥杆阶段的峰值。
Equinus deformity is a common problem in children with spastic cerebral palsy (CP). Persistent deformity that interferes with function is treated by surgically lengthening the triceps surae. Surgical approaches carry a recurrence risk of equinus deformity or over correction with the development of calcaneal deformity, crouch and diminished strength for push-off during gait. These aspects interfere with the basic function of the gastrocnemius/soleus complex. This study aimed to analyze kinematic and kinetic effects of gastrocnemius fascia lengthening on gait pattern in children with CP and, in particular, the evaluation of push-off ability before and after treatment. Twenty children with CP were evaluated by clinical examination and three-dimensional gait analysis (GA) before and after (12 months) gastrocnemius fascia lengthening surgery (modified Vulpius' technique) to improve equinus foot and walking. The results showed a significant reduction in equinus foot, represented by a re-duction in the â angle (the angle between the foot and the ground on the sagittal plane) at initial contact (IC), closer to healthy children, and increased ankle power generation during push-off. Even if this result was not of a statistically significant level, it is important because it means that the surgery did not produce a functional weakness. Kinetic results showed an improvement (ankle joint power absorbed and generated) related to a more functional walking behavior. Some improvements concerning the knee joint are significant, in particular, the value of the knee angle at IC and of peak during the swing phase.