Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy: A randomized controlled trial
Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy: A randomized controlled trial
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DOI：
10.1016/j.gaitpost.2017.12.004
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发表时间：
2018-02-01
期刊：
影响因子：
2.4
通讯作者：
Dreher, T.
中科院分区：
文献类型：
--
作者：
Klotz, M. C. M.;Krautwurst, Britta K.;Dreher, T.
背景资料：本研究的目的是探讨髌腱缩短（PTS）是否作为SEMLS的一部分方法：采用随机对照研究方法，对22例脑瘫患儿行单次多节段手术治疗，观察其膝关节屈曲步态的恢复情况。（年龄：10.4 +/- 2.6岁，GMFCS I-III级）随机分配至两组（1：SEMLS+ PTS; 2：SEMLS无PTS）：进行SEMLS以矫正屈曲膝步态，伴或不伴额外PTS。术前和术后（随访：12.7 +/- 1.6个月）的运动学（3-D运动分析）和临床参数进行了比较。SEMLS后两组的最大膝关节伸展度均显著改善，而附加PTS的患者显示出更大的矫正度（SEMLS+ PTS：37.6度至11.4度，p = 0.007; SEMLS无PTS：35.1度至21.8度，p = 0.016）。在“SEMLS+ PTS”组中，术后膝关节屈曲峰值显著降低（14.6度，p = 0.004），而另一组中无相关变化。两组术后骨盆前倾角均有增加趋势，但无统计学差异。术后膝关节屈曲挛缩（15.9 °，p < 0.001）和腘动脉角（27.2 °，p = 0.009）仅在“SEMLS+ PTS”组中显著降低。结论：PTS可有效纠正屈曲膝步态和膝关节屈曲挛缩，从而使上级站立相膝关节伸展。然而，额外的PTS可能会导致膝关节步态僵硬和骨盆前倾角增加。
Background: The aims of this study were to investigate if patellar tendon shortening (PTS) as a part of SEMLS (single event multilevel surgery) is effective for reduction of flexed knee gait in children with cerebral palsy (CP) and, if PTS leads to stiff knee gait.Methods: In a randomized controlled study 22 children with flexed knee gait (age: 10.4 +/- 2.6 years, GMFCS Level I-III) were randomized and allocated to two groups (1: SEMLS+ PTS; 2: SEMLS no PTS): SEMLS was performed for correction of flexed knee gait either with or without additional PTS. Before and after surgery (follow up: 12.7 +/- 1.6 months) kinematics (3-D motion analysis) and clinical parameters were compared.Results: Two children were lost to follow up. Maximum knee extension improved significantly in both groups after SEMLS while the patients with additional PTS showed much more correction (SEMLS+ PTS: 37.6 degrees to 11.4 degrees, p = 0.007; SEMLS no PTS: 35.1 degrees to 21.8 degrees, p = 0.016). After surgery peak knee flexion decreased significantly (14.6 degrees, p = 0.004) in the "SEMLS+ PTS" group while there was no relevant change in the other group. There was a trend of increase in anterior pelvic tilt after surgery in both groups, but no statistical significant difference. After surgery knee flexion contracture (15.9 degrees, p < 0.001) and popliteal angle (27.2, p = 0.009) measured on clinical examination only decreased significantly in the "SEMLS+ PTS" group.Conclusion: PTS is effective for correction of flexed knee gait and knee flexion contracture leading to superior stance phase knee extension. However, additional PTS may lead to stiff knee gait and a higher increase of anterior pelvic tilt.