Distal hamstring lengthening in cerebral palsy

Summary Distal elongation of the hamstrings was performed for contracture due to neurogenic disorders in 66 patients. A follow-up study on 34 of the patients with cerebral palsy is reported here. The success of the operation was judged by functional evaluation including joint measurement and gait analysis. The advantages of this operation and the need for prolonged aftercare are discussed.

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Résumé La contracture d'origine neurologique a été corrigée chez 66 malades par allongement des ischiojambiers au niveau de leurs tendons terminaux. L'article étudie les résultats à long terme obtenus chez 34 infirmes moteurs cérébraux. L'efficacité de l'intervention a été évaluée sur le plan fonctionnel d'après la mobilité articulaire et la qualité de la marche. La discussion porte sur les avantages de cette opération et la nécessité de soins post-opératoires prolongés.

     

Flexed-knee gait in children with cerebral palsy: a 10-year follow-up study

Background

While several studies have evaluated the short-term effectiveness of conservative and surgical treatment of flexed-knee gait in children with cerebral palsy (CP), few have explored the long-term outcomes using gait analysis. The purpose of this study was to examine, through gait analysis, the 10-year outcomes of flexed-knee gait in children with CP.

Methods

Ninety-seven children with spastic CP who walked with a flexed-knee gait underwent two gait evaluations [age 6.1 ± 2.1 and 16.2 ± 2.3 years, Gross Motor Function Classification System (GMFCS) I (12), II (45), III (37), IV (3)]. Limbs with knee flexion at initial contact >15° were considered walking with a flexed-knee gait and were included in the study (n = 185). Kinematic data were collected using an eight-camera motion analysis system (Motion Analysis, Santa Rosa, CA). Surgical and therapeutic interventions were not controlled.

Results

A comparison between the two gait studies showed an overall improvement in gait at 10 years follow-up. Significant improvements were seen in knee flexion at initial contact, Gait Deviation Index (GDI), Gross Motor Function Measure (GMFM), and gait speed (P < 0.01 for all). Outcome was also evaluated based on the severity of flexed-knee gait at the initial visit, with functional skills and overall gait (GDI) improving in all groups (P < 0.01 for all). The group with a severe flexed-knee gait exhibited the most improvement, while subjects with a mild flexed-knee improved the least.

Conclusions

Children at a specialty hospital whose orthopedic care included gait analysis and multi-level surgery showed improvement of flexed-knee gait and gross motor function over a 10-year course, regardless of the initial severity.     

Changes in gait patterns after operations in children with spastic cerebral palsy

Summary We have utilised a scoring system with the aid of a specially designed worksheet to measure gait ability in spastic children with cerebral palsy before and after corrective soft tissue operations. Postoperatively, there were obvious improvements in gait especially in the mobility of the leg and the foot. Comparison between a visually assessed score and objectively recorded values using foot-switches showed a good correlation. The postoperative improvement was most obvious in hemiplegic children, but was also present in diplegic children following both single and complex one-stage operations.

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Résumé Afin de mesurer les possibilités de marche chez les enfants spastiques atteints de paralysie cérébrale, nous avons utilisé une cotation obtenue grâce à une abaque spécialement réalisée pour cette investigation. Les mesures ont été faites avant et après les opérations correctrices portant sur les parties molles.En post-opératoire on a noté une amélioration indiscutable de la marche, notamment en ce qui concernait la mobilité de la jambe et du pied. La comparaison entre l'estimation visuelle et les enregistrements objectifs a montré une bonne corrélation. L'amélioration post-opératoire est plus marquée chez les enfants hémiplégiques, mais elle existe aussi chez les enfants diplégiques, tant après des interventions simples que complexes.

     

Stair-shaped Achilles tendon lengthening in continuity — A new method to treat equinus deformity in patients with spastic cerebral palsy

Background

Equinus of the ankle is a common deformity in spastic cerebral palsy. Achilles tendon lengthening is one of the effective options for the treatment of equinus deformity.

Comparison of hamstring lengthening with hamstring lengthening plus transfer for the treatment of flexed knee gait in ambulatory patients with cerebral palsy

Purpose

Children with spastic diplegic and hemiplegic cerebral palsy frequently ambulate with flexed knee gait. There has been concern that hamstring lengthening used to treat this problem may weaken hip extension. This study evaluates the primary outcome of hamstring transfer plus lengthening in comparison with traditional hamstring lengthening in treating flexed knee gait in ambulatory patients with cerebral palsy.

Methods

A total of 47 children (67 lower limbs) ranging in age from 5 to 17 years old were included in this study. All subjects underwent a variety of additional surgeries at the time of the hamstring surgery as part of a multilevel treatment plan. All patients who met the inclusion criteria were divided into two groups, the hamstring lengthening alone group (HSL) and the hamstring transfer plus lengthening group (HST). Full gait analysis studies were done for all subjects pre-operatively and 1 year post-operatively.

Results

There were 25 patients (35 limbs) in the HSL group and 22 patients (32 limbs) in the HST group. There was no significant difference in age, gender, or the time from surgery to post-operative gait analysis between groups. On physical examination, both HSL and HST groups showed improvement in passive knee extension, popliteal angle, and straight leg raise. Maximum knee extension in stance phase was improved in both groups. The maximum hip extension in late stance phase was significantly improved only in the HST group. The peak hip extension power in stance phase showed significant improvement only in the HST group and a significant decrease for the HSL group.

Conclusions

The findings of this study demonstrated that both the HSL and HST procedures resulted in similar amounts of improvement in passive range of motion of the knee, as well in knee extension in stance during gait at 1 year post-operatively. However, with the HST procedure, there was better preservation of hip extension power and improved hip extension in stance. The HST procedure should be considered when hamstring surgery is performed.     

Comparison of hamstring transfer with hamstring lengthening in ambulatory children with cerebral palsy: further follow-up

Background

Overactivity or contractures of the hamstring muscles in ambulatory children with cerebral palsy (CP) can lead to either a jump gait (knee flexion associated with ankle plantar flexion) or a crouch gait (knee flexion associated with ankle dorsiflexion). Hamstring lengthening is performed to decrease stance knee flexion. However, this procedure carries the potential risk of weakening hip extension power as well as recurrence over time; therefore, surgeons have adopted a modified procedure wherein the semitendinosus and gracilis are transferred above the knee joint, along with lengthening of the semimembranosus and biceps femoris.

Purpose

The purpose of our study is to evaluate the differences between hamstring lengthening alone (HSL group) and hamstring lengthening plus transfer (HST group) in the treatment of flexed knee gait in ambulatory children with CP. We hypothesized that recurrence of increased knee flexion in the stance phase will be less in the HST group at long-term follow-up, and hip extensor power will be better preserved.

Methods

Fifty children with CP who underwent hamstring surgery for flexed knee gait were retrospectively reviewed. All subjects underwent a pre-operative gait study, a follow-up post-operative gait study, and a long-term gait study. The subjects were divided into two groups; HSL group (18 subjects) or HST group (32 subjects). The mean age at surgery was 9.9 ± 3.3 years. The mean follow-up time was 4.4 ± 0.9 (2.7–6.3) years.

Results

On physical examination, both groups showed improvement in straight leg raise, knee extension, popliteal angle, and maximum knee extension in stance at the first post-op study, and maintained this improvement at the long-term follow-up, with the exception of straight leg raise, which slightly worsened in both groups at the final follow-up. Both groups improved maximum knee extension in stance at the initial follow-up, and maintained this at the long-term follow-up. Only the HST group showed significant (p < 0.05) improvement in the peak hip extension power in stance at the first post-op study, and this increased further at the final follow-up. In the HSL group, there was an initial slight decrease in the hip extension power, which subsequently increased to pre-operative values at the long-term study. Only the HST group showed increase of the average anterior pelvic tilt at the long-term follow-up study, although this was small in magnitude. There were two subjects who developed knee recurvatum at the post-op study, and both were in the HST group.

Conclusions

There is no clear benefit in regards to recurrence when comparing HST to HSL in the long term. In both HSL and HST, there was reduction of stance phase knee flexion in the long term, with no clear advantage in either group. Longer follow-up is needed for additional recurrence information. There was greater improvement of hip extension power in the HST group, which may justify the additional operative time of the transfer.

Significance

This study helps pediatric orthopedic surgeons choose between two different techniques to treat flexed knee gait in patients with CP by showing the long-term outcome of both procedures.     

Lever arm dysfunction in cerebral palsy gait

Skeletal structures act as lever arms during walking. Muscle activity and the ground reaction against gravity exert forces on the skeleton, which generate torque (moments) around joints. These lead to the sequence of movements which form normal human gait. Skeletal deformities in cerebral palsy (CP) affect the function of bones as lever arms and compromise gait. Lever arm dysfunction should be carefully considered when contemplating treatment to improve gait in children with CP.     

Comparison of rectus femoris transposition with traditional transfer for treatment of stiff knee gait in patients with cerebral palsy

Purpose To assess the outcome of children with cerebral palsy following reposition of the distal rectus femoris tendon for treatment of stiff knee gait. Methods Children with cerebral palsy with stiff knee gait who underwent rectus femoris transfer were studied retrospectively. Inclusion criteria were cerebral palsy of diplegic or quadriplegic type, preoperative and 1 year postoperative three-dimensional motion analysis, and no other surgery except rectus femoris transfer at the time of study. The patients were separated into two groups: in group I, the rectus femoris was transferred to the distal medial hamstring tendons, either the gracilis or the semitendinosus; in group II, the distal tendon of the rectus femoris was transposed laterally and attached to the iliotibial band/intermuscular septum. Results Peak knee flexion during swing phase, total dynamic knee range of motion, knee range of motion during swing phase, and time to peak knee flexion during swing phase were all improved in both groups. Hip and pelvic kinematics were not influenced by the surgery. Velocity, stride length, and cadence were all improved following the surgery. There was no difference between the transfer group and the transposition group. Conclusion These findings suggest that distal transfer of the rectus femoris is effective in improving swing phase knee function by diminishing the mechanical effect of the dysphasic swing phase activity of the rectus femoris, not by converting the rectus femoris to an active knee flexor. No financial support was received for this study.     

What are the long-term outcomes of lateral column lengthening for pes planovalgus in cerebral palsy?

BackgroundLateral column lengthening (LCL) is commonly performed on children and adolescents with cerebral palsy (CP) for correction of pes planovalgus (PPV). There are limited reports of the long-term outcomes of this procedure. The purpose of this study was to examine the long-term results of LCL for correction of PPV in individuals with CP by evaluating subjects when they had transitioned to adulthood and were entering the workforce.MethodsClinical assessments, quantitative gait analysis including the Milwaukee Foot Model (MFM) for segmental foot kinematics, and patient reported outcomes were collected from 13 participants with CP treated with LCL for PPV in childhood (average age 24.4 ± 5.7 years, average 15.3 ± 8.5 years since LCL). Additionally, 27 healthy adults average age 24.5 ± 3.6 years functioned as controls.ResultsStrength and joint range of motion were reduced in the PPV group (p < 0.05). Sixty nine percent showed operative correction of PPV based on radiologic criteria. Gait analysis showed reduced walking speed and stride length, as well as midfoot break and residual forefoot abduction. Patient reported outcomes indicated that foot pain was not the only factor that caused limited activity and participation. LCL surgery for PPV in childhood resulted in long-term operative correction. Decreased ankle passive range of motion and strength, subtalar joint arthritic changes, inefficient and less stable ambulation, and problems with participation (difficulties in physical function, education, and employment) were observed in the long-term.ConclusionThis study identified postoperative impairments and limitations to guide future clinical decision-making. These results provide clinicians and researchers the common residual and recurrent issues for these individuals as they age. The inclusion of contextual factors that influence the disease and impairments can equip these individuals with enhanced skills they need as they transition into adulthood.     

The effect of community-prescribed ankle–foot orthoses on gait parameters in children with spastic cerebral palsy

Purpose To evaluate the efficacy of ankle foot orthoses (AFOs) prescribed in the community for children with cerebral palsy (CP). Methods Fifty-six children (32 boys and 24 girls, mean age 8.9 years, range 4–17) who were diagnosed as having CP were enrolled. They were grouped according to the type of CP, diplegic (n = 38) and hemiplegic (n = 18). Three-dimensional gait analyses while patient were barefoot and with AFOs were obtained and analyzed. Results The spatio-temporal findings were the most significantly changed as a result of AFO use. In the hemiplegic group, stride length was 11.7% (p = 0.001) longer with AFOs in both affected (10.2%) and non-affected (12.4%) legs, and cadence was reduced by 9.7%; walking speed was not affected. In the diplegic group, stride length with AFOs was 17.4% longer compared to barefoot (p < 0.001) and walking velocity improved by 17.8% (p < 0.001); cadence was unchanged. AFOs also increased ankle dorsiflexion at initial contact in both groups. In the hemiplegic group, AFOs produced an average 9.4° increase of dorsiflexion at initial contact (IC) on the affected side (p < 0.001) and 5.87° on the unaffected side (p = 0.007), and an increase of 9.9° (p < 0.001) dorsiflexion at swing, on the affected side. In the diplegic group, dorsiflexion at IC was increased by 13.4° on the right side and 7.8° on the left side (p = 0.05; p > 0.001, respectively) and an increase of 6° (p = 0.005) at swing. In the hemiplegic group of patients, knee flexion at initial contact on the affected side was reduced by 8.5° (p = 0.032) while in the diplegic group we found no influence. The number of patients that reached symmetry at initial double support tripled (from 5.6 to 16.7%) with the use of AFOs. Conclusions Our results showed that the use of AFOs improves spatio-temporal gait parameters and gait stability in children with spastic cerebral palsy. It has a lesser effect on proximal joint kinematics. Children with spastic hemiplegia display greater improvement than those with spastic diplegia.     

Surgical correction of equinus deformity in children with cerebral palsy: a systematic review

Purpose  

Equinus is the most common deformity in cerebral palsy. However, despite the large volume of published studies, there are poor levels of evidence to support surgical intervention. This study was undertaken to examine the current evidence base for the surgical management of equinus deformity in cerebral palsy.     

Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy

Purpose

Planovalgus foot deformity is common in diplegic and quadriplegic patients. Surgery is the definitive treatment to restore the alignment of the talus, calcaneus, and navicular bones. We aimed, in the current study, to compare the effectiveness of subtalar fusion and calcaneal lengthening, and to assess the recurrence in ambulatory children with cerebral palsy.

Methods

This is a retrospective study of 78 patients (138 feet diagnosed with planovalgus deformity) who underwent surgical correction using subtalar fusion or calcaneal lengthening. Range of motion, radiographic indices, kinematic, and pedobarographic data were used to examine the deformity and the outcome of surgery. A repeated measures analysis of variance (ANOVA) was used to test the study hypothesis.

Results

Most of the patients were diplegic (87.2 %) and the mean age at surgery was 11.9 ± 2.9 years (range from 4.7 to 18.3 years), with a mean follow-up of 5 ± 4.4 years (range from 1 to 15.4 years). Sixty-three feet were treated with calcaneal lengthening, while 75 were treated with subtalar fusion. The feet treated with subtalar fusion were more severe preoperatively. However, both surgery groups showed improvement postoperatively. Among 12 cases of recurrence, medial column fusion was the main surgery performed to correct the deformity.

Conclusions

Surgery is effective in the treatment of planovalgus deformity in ambulatory children with cerebral palsy. Severe and rigid planovalgus feet can be treated effectively with subtalar fusion. Feet with milder deformity show good results, with calcaneal lengthening. Surgery provides good correction in young patients, but there is a higher recurrence rate.

Electronic supplementary material

The online version of this article (doi:10.1007/s11832-012-0413-3) contains supplementary material, which is available to authorized users.     

Surgical treatment of equinus deformity in cerebral palsy by aponeurosis lengthening and Z-lengthening

Abstract Surgical treatment of equines deformity in cerebral palsy can be carried out successfully by Achilles tendon lengthening and gastrocnemius aponeurosis lengthening. From 1993 to 1998, we performed 59 operations in 37 cerebral palsied patients with equinus deformity using Z-lengthening in 30 cases and a modified Bakers procedure in 29 cases. The operations, associated with other hip and knee procedures in 65% of patients, were followed by postoperative use of casts and by a 12-month intensive kinesitherapeutic protocol. On preoperative evaluation, besides pattern deformity and the condition of proximal joints, we considered also age, clinical diagnosis, nature of tone and muscle strength. In most cases, the retrospective analysis showed the correction of deformity and a functional improvement. We observed 9 recurrences in six of the younger patients without relationship with topographic pattern of cerebral palsy. Overcorrection of equines deformity occurred in one diplegic child who had phasic hypertonia and low muscle strength. We believe that the evaluation of patients, the preoperative planning and the effective kinesitherapeutic program are necessary to reduce the risk of complications related to surgery.     

High resolution muscle measurements provide insights into equinus contractures in patients with cerebral palsy

Muscle contractures that occur after upper motor neuron lesion are often surgically released or lengthened. However, surgical manipulation of muscle length changes a muscle's sarcomere length (L_s), which can affect force production. To predict effects of surgery, both macro‐ (fascicle length (L_f)) and micro‐ (L_s) level structural measurements are needed. Therefore, the purpose of this study was to quantify both L_s and L_f in patients with cerebral palsy (CP) as well as typically developing (TD) children. Soleus ultrasound images were obtained from children with CP and TD children. L_f was determined and, with the joint in the same position, CP biopsies were obtained and formalin fixed, and L_s was measured by laser diffraction. Since soleus L_s values were not measurable in TD children, TD L_s values were obtained using three independent methods. While average L_f did not differ between groups (CP = 3.6 ± 1.2 cm, TD = 3.5 ± 0.9 cm; p > 0.6), L_s was dramatically longer in children with CP (4.07 ± 0.45 µm vs. TD = 2.17 ± 0.24 µm; p < 0.0001). While L_f values were similar between children with CP and TD children, this was due to highly stretched sarcomeres within the soleus muscle. Surgical manipulation of muscle‐tendon unit length will thus alter muscle sarcomere length and change force generating capacity of the muscle. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:33–39, 2015.     

Botulinum toxin A treatment of the lower extremities in children with cerebral palsy

Objectives

In the last 2 decades, BTX-A is increasingly being used in the management of spasticity in children with Cerebral Palsy (CP) and there is no doubt about its effect on range of motion, spasticity reduction and gait pattern in this patient population. However, in daily practice, there is still an ongoing search for the best way to apply BTX-A. Two studies were set up to evaluate how successful an integrated multilevel treatment approach is in children with CP. The first study identifies crucial factors within the treatment strategy which may predict the outcome. The second study evaluates the efficacy of repeated BTX-A injections.

Methods

Patient selection was based on following criteria: diagnosis of CP, lower limb BTX-A treatment, age at time of treatment <24 years, no combined surgery at the time of BTX-A injections, 3D gait analysis and clinical evaluation pre and 2 months post BTX-A injections. The first study included the last treatment of 577 patients. In the second study, the first and last BTX-A treatment of 222 children were included. The Goal Attainment Scale (GAS) was used to evaluate the functional outcome of each treatment session.

Results

In the first study, the mean GAS score of the total group was 51.7 (±7.5). Considering a converted total score of 50 as cut-off score for successful treatment, 67.1 % of the treatments were successful. Significantly higher GAS scores were found in mildly involved children compared to more involved children (p < 0.0001) and for multilevel injections or injections in the distal muscle groups only compared to injections in the proximal muscles of the lower limb only (p < 0.0001). Other crucial factors for a successful outcome were amount of physical therapy per week (p=0.0026), post injection casting (p=0.005) and frequency of using day and night orthoses after injection (p < 0.0001). In the second study, the mean GAS score of the total group decreased from 54.8 (±6.8) at the first treatment to 50.7 (±6.9) at the last treatment, indicating that on average, repeated BTX-A treatment is successful.

Conclusion

The integrated multilevel BTX-A approach is successful in children with CP. Several factors might help the clinician to select patients that are most likely to benefit from the treatment, to assure the most optimal treatment strategy and to predict the outcome. Each treatment should be carefully planned and goals should be well chosen, because the effectiveness of the BTX-A treatment may decrease with increasing number of treatments in the same patient.     

The effect of surface and internal electrodes on the gait of children with cerebral palsy, spastic diplegic type

The purpose of this study was to determine whether surface and internal fine-wire electromyography electrodes had an effect on gait. The subjects for the experiments were 38 children with the spastic diplegic type of cerebral palsy. The children were filmed using the high-speed cinematographic technique while they walked (a) with no electrodes (unencumbered), (b) with only surface electrodes, and (c) with internal electrodes. Single stance time, step length, cadence, and walking velocity were compared with analysis of variance and Bonferroni t tests. The results included a significant decrease in cadence (-6.3% of unencumbered walking; p less than 0.05) when comparing walking with surface electrodes with walking without any electrodes. The internal electrodes caused significant decreases from normal walking in the following parameters: step length for both the measured leg (-18.6%; p less than 0.005) and the nonmeasured leg (-18.0%; p less than 0.005), cadence (-7.9%; p less than 0.02), and walking velocity (-23.5%; p less than 0.005). Internal electrodes caused significant decreases as compared with surface electrodes in the step length for both the measured leg (15.7%; p less than 0.01) and the nonmeasured leg (15.6%; p less than 0.005) and walking velocity (19.7%; p less than 0.005). Single stance phase did not change significantly in any of the comparisons. It appears that the addition of the surface electrode apparatus does change the normal gait of a subject, causing a large decrease in cadence. The measurement of gait with internal electrodes causes further change in gait, resulting in large decreases in step length and walking velocity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Stiff muscle fibers in calf muscles of patients with cerebral palsy lead to high passive muscle stiffness

Cerebral palsy (CP), caused by an injury to the developing brain, can lead to alterations in muscle function. Subsequently, increased muscle stiffness and decreased joint range of motion are often seen in patients with CP. We examined mechanical and biochemical properties of the gastrocnemius and soleus muscles, which are involved in equinus muscle contracture. Passive mechanical testing of single muscle fibers from gastrocnemius and soleus muscle of patients with CP undergoing surgery for equinus deformity showed a significant increase in fiber stiffness (p < 0.01). Bundles of fibers that included their surrounding connective tissues showed no stiffness difference (p = 0.28).). When in vivo sarcomere lengths were measured and fiber and bundle stiffness compared at these lengths, both fibers and bundles of patients with CP were predicted to be much stiffer in vivo compared to typically developing (TD) individuals. Interestingly, differences in fiber and bundle stiffness were not explained by typical biochemical measures such as titin molecular weight (a giant protein thought to impact fiber stiffness) or collagen content (a proxy for extracellular matrix amount). We suggest that the passive mechanical properties of fibers and bundles are thus poorly understood. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1667–1674, 2014.     

The effect of tuning ankle foot orthoses-footwear combinations on gait kinematics of children with cerebral palsy: A case series

Study designCase series.BackgroundAFOs are a commonly prescribed medical device given to children with cerebral palsy (CP) in an attempt to improve their gait. The current literature is equivocal on the effects AFOs have on the gait of children with CP. The vast majority of AFOs issued are not subject to AFO-FC tuning. There are emerging studies investigating the effects tuning AFO-FCs has on the gait of children with CP. However, the research is limited, and there is a lack of quantitative data.ObjectiveTo compare the kinematics of tuned versus non-tuned gait in children with CP.MethodsGait analysis assessment of five children aged between 7–11 years with a diagnosis of CP (one hemiplegic and four diplegic participants, two female, three male, with a Gross Motor Functional Classification System (GMFCS) of 2) at a Gait Analysis Laboratory.ResultsIn comparison to barefoot and non-tuned gait, walking with a tuned AFO-FC produced improvements in several key gait parameters. Including hip flexion and extension, posterior pelvic tilt and knee extension. Results also indicated that the type of gait pattern demonstrated by the participant affected the outcomes of tuning.ConclusionsTuning the AFO-FC of children with CP has the potential to improve hip function, pelvic function, knee extension in stance phase and knee flexion during swing phase and that a non-tuned AFO-FC can potentially decrease hip function, posterior pelvic tilt and increase knee extension.Clinical RelevanceWhilst AFO-FC tuning has been recommended for routine clinical practice, there still remains a paucity of research on the kinematic effects of using a tuned AFO-FC compared to a non-tuned. This paper provides a comparison of kinematics on children with CP, during barefoot, non-tuned and tuned AFO-FC walking with a view to inform clinical practice.     

内收短肌和股薄肌移位术治疗脑瘫剪刀步

目的探讨采用内收短肌、股薄肌移位术治疗脑瘫剪刀步的疗效.方法自2000年7月至2004年12月采用内收短肌、股薄肌移位术为基本术式治疗脑瘫剪刀步73例,男47例,女26例;年龄为5～36岁,平均12.06岁.术前肌张力采用Ashworth法评估,1级12例,2级38例,3级18例,4级5例.术中将内收短肌止点切下,与阔筋膜张肌缝合;将股薄肌止点切下,经腘窝后方移位于股骨外髁;同时完成的手术还有髋松解术55例,腓肠肌内外侧头松解术23例,腘绳肌前移术37例,腘绳肌延长术13例,腓肠肌切断术32例,跟腱延长术30例,胫前肌外移术31例,腓骨长肌内移术8例.术后石膏托固定,6周后去除石膏行功能锻炼.手术疗效根据自行拟定的标准进行术后评估.结果术后随访6个月～4年5个月,平均24.4个月.所有患者剪刀步态均完全纠正.术后功能评估,优61例,良10例,可2例,优良率为97.25%.疗效欠佳的2例主要表现为膝部屈曲,服药后有所缓解.各组手术前后功能评分差异有统计学意义（P＜ 0.01）,术后D组与A组、B组差异有统计学意义（P＜0.05）.结论内收短肌、股薄肌移位术可有效纠正脑瘫患者剪刀步,术后功能满意;对下肢其他畸形应综合设计矫形方案,手术一次完成,以利于术后行步态训练;同时术后功能锻炼应与智商的提高相结合.