Lower limb extensor moments in children with spastic diplegic cerebral palsy
Lower limb extensor moments in children with spastic diplegic cerebral palsy
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DOI：
10.1016/j.gaitpost.2003.08.009
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发表时间：
2004-10-01
期刊：
影响因子：
2.4
通讯作者：
Gough, M
中科院分区：
文献类型：
--
作者：
McNee, AE;Shortland, AP;Gough, M
在这项回顾性研究中，我们量化了一组患有痉挛性瘫痪的独立行走儿童（n = 90；167条肢体）和一组正常发育（ND）儿童（n = 22；22条肢体）在站立期间踝关节、膝关节和髋关节的平均伸肌力矩。与正常发育的儿童相比，双瘫儿童的平均膝伸肌力矩和平均支撑力矩表现出更大的方差（P < 0.0001 和 P < 0.001）。这是因为受影响组中平均膝伸肌力矩与站立时最小膝关节屈曲之间存在很强的相关性（r(2) = 0.615；P < 0.0001），对于所有以大于 20 度膝关节屈曲行走的儿童来说，平均膝关节伸肌力矩为正值。我们还发现支撑力矩和膝关节屈曲之间存在线性关系（r(2) = 0.805；P < 0.0001）。我们的数据支持 Hof 的生物力学分析 [Gait Posture, 12 (2000) 196]，他建议修改后的支撑力矩应该是膝盖偏心率的线性函数。尽管最小膝关节屈曲和最小髋关节屈曲之间存在很强的正相关关系（r(2) = 0.316；P < 0.0001），但踝关节伸肌力矩（r(2) = 0.001376；P = 0.641）和髋关节伸肌力矩（r(2) = 0.0860；P = 0.000168）与膝关节屈曲增加的关系较弱。我们得出的结论是，患有痉挛性双瘫脑瘫（SDCP）的儿童以蹲伏步态行走，依靠伸膝肌来防止下肢塌陷。针对在下肢关节之间重新分配伸肌力矩的干预措施可能会减缓膝关节屈曲的增加并延长该组的合理步行功能。 (C) 2003 Elsevier B.V. 保留所有权利。
In this retrospective study, we quantified the mean extensor moment at the ankle, knee and hip over the stance period in a group of independently ambulant children with spastic diplegia (n = 90; 167 limbs) and in a group of normally-developing (ND) children (n = 22; 22 limbs). The mean knee extensor moment and the mean support moment demonstrated greater variance in children with diplegia than in normally-developing children (P < 0.0001 and P < 0.001). This was explained by a strong relationship between the mean knee extensor moment and minimum knee flexion in stance (r(2) = 0.615; P < 0.0001) in the affected group with a positive mean knee extensor moment for all those children who walked in greater than 20degrees of knee flexion. We also found a linear relationship between the support moment and knee flexion (r(2) = 0.805; P < 0.0001). Our data supported the biomechanical analysis of Hof [Gait Posture, 12 (2000) 196] who suggested that his modified support moment should be a linear function with eccentricity at the knee. Extensor moments at the ankle (r(2) = 0.001376; P = 0.641) and hip (r(2) = 0.0860; P = 0.000168) bore weak relationships with increasing knee flexion even though there was a strong positive relationship between minimum knee flexion and minimum hip flexion (r(2) = 0.316; P < 0.0001). We conclude that children with spastic diplegic cerebral palsy (SDCP) who walk with a crouch gait rely on their knee extensors to prevent collapse of the lower limbs. Intervention directed at redistributing extensor moments between the joints of the lower limbs may slow the increase in knee flexion and prolong reasonable walking function in this group. (C) 2003 Elsevier B.V. All rights reserved.