Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy
Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy
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DOI：
10.1016/j.gaitpost.2013.10.020
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发表时间：
2014-02-01
期刊：
影响因子：
2.4
通讯作者：
Miller, Freeman
中科院分区：
文献类型：
--
作者：
Kadhim, Muayad;Miller, Freeman
脑性瘫痪(CP)的儿童由于肌肉痉挛可能会出现几种步态模式，通常为蹲下步态。有几个因素可能会导致步态中膝关节持续屈曲，包括腿筋和腓肠肌痉挛。在扁平外翻足畸形中，足跟马蹄、距舟关节脱位、足中骨折和胫骨外扭伤的联合作用也是作为杠杆臂功能障碍的一部分而导致的蹲姿。在这项回顾性队列研究中，我们评估了21名患有脑瘫的儿童(34足)，他们接受了平面外翻足矫正术作为单节段手术。距下融合15足，跟骨外侧延长19足。接受过膝盖、髋部或骨盆手术的患者被排除在研究之外。目的是研究足部手术后步态模式的变化以及站立相膝关节屈曲变化与其他运动学和动力学参数的相关性。术后膝关节最大站立伸展的变化(MKE-dif)是令人感兴趣的结果。术前平外翻足较轻、术前踝关节最大站立时背屈和踝关节力量较高的患者，术后MKE的变化幅度增加(术后蹲伏较少)。术后膝关节伸展的增加与踝关节过度背屈的矫正有关，与初次接触时膝关节伸展的增加和膝力的增加有关。术前踝关节最大背屈高度的患者可以从手术矫正足部畸形中受益，以达到减少踝关节背屈的目的，而不需要膝关节手术干预。(C)2013爱思唯尔B.V.保留所有权利。
Ambulatory children with cerebral palsy (CP) may present with several gait patterns due to muscular spasticity, commonly with crouch gait. Several factors may contribute to continuous knee flexion during gait, including hamstring and gastrocnemius contracture. In planovalgus foot deformity, the combination of heel equinus, talonavicular joint dislocation, midfoot break and external tibial torsion also contribute to crouch gait as part of lever arm dysfunction. In this retrospective cohort study, we assessed 21 children with CP (34 feet) who underwent planovalgus foot correction as a single level surgery. Fifteen feet underwent subtalar fusion and 19 feet had lateral calcaneal lengthening. Patients who underwent knee, hip or pelvis surgeries were excluded from the study. The aim was to examine the changes in gait pattern and the correlation between the changes of knee flexion at stance phase with the other kinematic and kinetic parameters after foot surgery. Post surgery change of Maximum knee extension at stance (MKE-dif) was the outcome of interest. The magnitude of change in MKE after surgery increased (less crouch after surgery) in patients who had milder preoperative planovalgus feet and higher preoperative ankle maximum dorsiflexion at stance and ankle power. The gain of knee extension after surgery correlated with correction of ankle hyperdorsiflexion and with increase of knee extension at initial contact and knee power. Patients with high preoperative ankle maximum dorsiflexion may benefit from surgical foot deformity correction to achieve decreased ankle dorsiflexion with no knee surgical intervention. (C) 2013 Elsevier B.V. All rights reserved.