痉挛型脑瘫患者功能性选择性脊神经后根切断术前后的三维步态特征分析

目的分析痉挛型脑瘫患者功能性选择性脊神经后根切断(functional selective posterior rhizotomy,FSPR)手术前后的步态特征,客观量化评估手术疗效。方法选取15名将要进行FSPR手术治疗的痉挛型脑瘫患者,应用VICON三维运动捕捉系统结合AMTI三维测力台对患者进行手术前后的步态采集,分析手术前后步态的时空、运动学及动力学参数。结果手术后,左、右支撑时间均大于手术前,左侧步长明显大于手术前,步高、步速及冠状面重心偏移均小于手术前;着地时的膝关节矢状面角度(即屈伸角度)出现明显提高,髋、踝关节未见明显差异。手术后,步行过程中左右侧髋、膝、踝关节活动范围(range of motion,ROM)在矢状面均出现不同程度的提高,且有统计学差异;右踝关节冠状面ROM也出现明显提高。手术后,右膝关节最小屈曲角度及左、右踝关节最大跖屈角度均出现显著减小;左、右侧支撑相最大垂直力较手术前明显提高,而下肢关节力矩未见明显差异。结论三维步态分析可以在一定程度上评估痉挛型脑瘫患者FSPR手术的疗效。术后痉挛型脑瘫患者的痉挛得到缓解,对步态的时空参数及下肢关节运动学参数改善比较明显,而对于动力学参数改善相对不明显,需进行进一步康复治疗。

Analysis of Three-Dimensional Gait Characteristics before and after FSPR Surgery of Patients with Spastic Cerebral Palsy

Objective To analyze gait characteristics of patients with spastic cerebral palsy (CP) before and after functional selective posterior rhizotomy (FSPR) surgery, so as to evaluate curative effects of the surgery objective ly. MethodsFifteen patients with spastic CP to be treated by FSPR were selected. The VICON three-dimensional (3D) motion analysis system and AMTI 3D force plates were used to collect and analyze the spatiotemporal gait parameters, kinematic and dynamic parameters before and after FSPR surgery. Results After the surgery, the left and right support phases were longer,and the left-side step length was significantly larger. The step height, velocity and the max displacement of center of gravity (COG) in coronal plane were smaller than those before surgery.The sagittal plane angle (flexion and extension angle) of the knee during initial landing was significantly increased, while no significant differences were found in that of the hip and ankle.The range of motion (ROM) of the left/right hip, knee and ankle in sagittal plane was increased to some extent during walking, with statistical differences. The ROM of right ankle in coronal plane was also increased obviously. The minimum flexion angle of the right knee and the maximum plantar flexion angle of the left/right ankle were significantly reduced. The maximum vertical forces of left and right support phases were significantly increased, while no significant differences were found in torque of lower limbs. Conclusions The 3D gait analysis can be used to evaluate the effect of FSPR on patients with spastic CP. The spasticity of patients with spastic CP is relieved after FSPR surgery, and the spatiotemporal gait parameters and kinematics parameters are improved significantly. But the improvement of dynamic parameters was not obvious, and further rehabilitation treatment is needed.