Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy
Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy
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DOI：
10.1097/00004694-199811000-00004
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发表时间：
1998-11-01
影响因子：
1.7
通讯作者：
Walsh, JHP
中科院分区：
文献类型：
--
作者：
DeLuca, PA;Ounpuu, S;Walsh, JHP
本研究的目的是评估腿筋延长和骨盆边缘腰肌后退 (OTB) 对痉挛性脑瘫患者步态中骨盆功能的影响。根据手术干预，73 名患者被分为四组：内侧腘绳肌 (n = 37)、内侧和外侧腘绳肌 (n = 12)、内侧腘绳肌合并腰肌 OTB (n = 9) 以及内侧和外侧腘绳肌合并腰肌 OTB (n = 15)。三维步态分析在手术前和术后 1 年内完成。当术前步态中骨盆位置正常或位于正常位置的后侧时，当内侧和外侧腘绳肌延长时，骨盆倾斜显着增加（p < 0.05），无论是否同时进行腰肌 OTB 手术。无论术前骨盆位置如何，单独使用内侧腘绳肌，无论是否同时存在腰肌 OTB，都不会导致骨盆位置发生显着变化。唯一能减少术前骨盆前倾过度的手术组合是内侧和外侧腘绳肌与腰肌 OTB，即 4 度的变化，临床意义有限。一般来说，腰肌和内侧腿筋手术对步态期间骨盆位置的影响很小。如果术前骨盆位置正常或稍微向后倾斜，内侧和外侧腘绳肌延长会增加骨盆倾斜。这项研究的结果表明，术后步态期间骨盆位置的基本决定因素是腘绳肌手术的范围（仅内侧腘绳肌与内侧和外侧腘绳肌延长）和术前骨盆位置。
The purpose of this study was to evaluate the effects of hamstring lengthenings and psoas recessions over the brim of the pelvis (OTB) on pelvic function in the gait of patients with spastic cerebral palsy. Seventy-three patients were divided into four groups based on surgical intervention: medial hamstrings (n = 37), medial and lateral hamstrings (n = 12), medial hamstrings with psoas OTB (n = 9), and medial and lateral hamstrings with psoas OTB (n = 15). Three-dimensional gait analysis was completed both before and similar to 1 year after surgery. When pelvic position in gait was normal or posterior of normal preoperatively, there was a significant increase in pelvic tilt (p < 0.05) when medial and lateral hamstrings were lengthened, irrespective of simultaneous psoas OTB surgery. Medial hamstrings alone, with or without simultaneous psoas OTB, did not result in a significant change in pelvic position, irrespective of preoperative pelvic position. The only surgical combination that caused a reduction in excessive preoperative anterior pelvic tilt was medial and lateral hamstrings with psoas OTB, a 4 degrees change of limited clinical significance. Tn general, psoas and medial hamstring surgery have minimal effect on the pelvic position during gait. Medial and lateral hamstring lengthening will increase pelvic tilt if preoperative pelvic position is normal or slightly posteriorly tilted. The results of this study suggest that the fundamental determinants of pelvic position during gait postoperatively are the extent of hamstring surgery (medial only vs. both medial and lateral hamstring lengthening) and the preoperative position of the pelvis.