Patellar tendon shortening for flexed knee gait in spastic diplegia
Patellar tendon shortening for flexed knee gait in spastic diplegia
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DOI：
10.1016/j.gaitpost.2015.01.018
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发表时间：
2015-02-01
期刊：
影响因子：
2.4
通讯作者：
Rutz, Erich
中科院分区：
文献类型：
--
作者：
Sossai, Roberto;Vavken, Patrick;Rutz, Erich
我们评估了三种不同方法治疗痉挛性截瘫屈膝步态患者的结果。这三种手术分别是髌腱缩短术（PTS）、PTS联合股骨和/或胫骨旋转截骨术、PTS联合股骨远端髁上延长截骨术（SEO）。主要结果指标是步态运动学。膝关节步态变量评分（GVS）和步态轮廓评分（GPS）源自步态运动学。 24 名患者（16 名男性和 8 名女性），平均年龄 16.1 岁（SD 5.8 岁），于 2002 年至 2008 年间接受手术，随访平均 22 个月。在整个步态周期中，步态期间的膝关节伸展度平均改善了 20 度，膝关节 GVS 改善了 14 度 (p < 0.001)。整体步态模式得到改善，GPS 平均降低 4.6 度。 Koshino 指数从术前的 1.34 改善至术后的 1.10（p < 0.001），证明了高髌骨的矫正。所有三个手术组的膝关节和步态运动学、体格检查指标和 Koshino 指数均有所改善，这表明针对痉挛性双侧瘫痪患者的屈膝步态进行量身定制的矫正方法是可行且适当的。 (C) 2015 Elsevier B.V. 保留所有权利。
We evaluated the outcome of three different approaches to the management of flexed knee gait patients with spastic diplegia. The three surgical procedures were patellar tendon shortening (PTS), PTS combined with rotational osteotomies of the femur and/or tibia, and PTS combined with supracondylar extension osteotomy (SEO) of the distal femur. The primary outcome measure was gait kinematics. The knee gait variable score (GVS) and the gait profile score (GPS) were derived from gait kinematics. 24 patients (16 male and 8 female), mean age 16.1 years (SD 5.8 years), who had surgery between 2002 and 2008, were followed for a mean of 22 months. Knee extension during gait improved by a mean of 20 degrees throughout the gait cycle, with an improvement in the knee GVS of 14 degrees (p < 0.001). The overall gait pattern improved with a mean decrease in GPS of 4.6 degrees. Correction of patella alta was demonstrated by an improvement in the Koshino index from 1.34 pre-operatively to 1.10 post-operatively (p < 0.001). Knee and gait kinematics, physical examination measures and Koshino Index improved in all three surgical groups, suggesting that a tailored approach to the correction of flexed knee gait in spastic diplegia is both feasible and appropriate. (C) 2015 Elsevier B.V. All rights reserved.