The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy.
The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy.
复制标题
DOI：
10.1186/s12891-021-04362-x
复制
发表时间：
2021-05-25
影响因子：
2.3
通讯作者：
Riad J
中科院分区：
文献类型：
--
作者：
Pantzar-Castilla E;Chen BP;Miller F;Riad J
确定膝关节屈曲步态手术方式的畸形指征和截断值尚不清楚。目的：探讨双侧脑性瘫痪(CP)儿童骨科手术前无或轻度、中度屈膝痉挛对术后步态改善的影响。纳入标准：双侧CP、粗大运动功能分级系统I-III级，以及手术前后步态分析。根据膝关节屈曲痉挛的严重程度将132例患者分为两组(组1：无或小于11°；组2：大于或等于11°)，然后根据所进行的完全相同的软组织和/或骨科手术进行匹配。手术的适应证是防止膝关节屈曲痉挛和站立时屈膝步态的进行性发展。对手术前后的体格检查和步态分析数据进行回顾性分析。60名(30 + )儿童，每组平均年龄10.6 岁。平均随访时间为17个 月。步态偏离指数由平均66(SD 19)改善至74(15)，p = 为0.004；2组由60(13)改善至69(15)，p = 为0.001。屈膝角度：第1组由21.4(16.1)度改善至12.1(16.0)度，p = 为0.002；第2组由32.2(14.2)度改善至17.0(15.9)度，p = 为0.001。两组步长均有改善，分别为p = 0.017和p = 0.008。仅第2组在步行速度、p = 0.018和站立功能、粗大运动功能评分、p = 0.001方面有显著改善。膝关节屈曲痉挛：第1组平均4.6(5.3)度至2.1(8.3)度，p = 为0.071；第2组由17.2(4.9)度降至9.6(9.3)度，p = 为0.001。除GMFM-D外，两组治疗前GDI及其他变量的改善差异均无统计学意义。相对轻到中度的术前膝关节屈曲痉挛不影响双侧脑性瘫痪儿童骨科手术后步态的短期改善。
Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP). Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively. Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D. Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.
登录
查看更多内容
影响因子：
2.4
作者：
Opheim, A.;McGinley, J. L.;Jahnsen, R.
通讯作者：
Jahnsen, R.
影响因子：
2.4
作者：
Sossai, Roberto;Vavken, Patrick;Rutz, Erich
通讯作者：
Rutz, Erich
影响因子：
2.4
作者：
McNee, AE;Shortland, AP;Gough, M
通讯作者：
Gough, M
影响因子：
2.4
作者：
Klotz, M. C. M.;Krautwurst, Britta K.;Dreher, T.
通讯作者：
Dreher, T.
影响因子：
2.4
作者：
Kadhim, Muayad;Miller, Freeman
通讯作者：
Miller, Freeman