BACKGROUND Hamstring lengthening remains the most common surgical procedure in the treatment of crouch gait for children with cerebral palsy (CP). While sagittal plane knee kinematics have been shown to improve post-surgery, the effects on transverse plane kinematics have not been reported. Given the differing actions of the medial and lateral hamstring muscles there is potential for change in tibial rotation post hamstring lengthening. RESEARCH QUESTION What is the effect of medial only versus combined medial and lateral hamstring lengthening on tibial rotation during gait in children with CP? METHODS A retrospective analysis of children with a diagnosis of CP who underwent a hamstring lengthening procedure. These children were divided into 2 groups: G1 (n = 18) had isolated medial hamstring lengthening while G2 (n = 30) had combined medial and lateral hamstring lengthening. A matched non-surgical control group (n = 15) was also included. Kinematic data were analysed pre and post-operatively. Pre-operative to post-operative outcomes for G1 and G2, a comparison at baseline for both groups and the difference in outcomes between the groups were analysed. Baseline to follow-up outcomes for the control group were also analysed. RESULTS External tibial rotation increased significantly within groups (G1: -10°, p < 0.01; G2: -11°, p < 0.001, control: -7.7, p < 0.01), with no significant difference in the change between the intervention groups. Foot progression angles became more external in both intervention groups (G1: -15°, p < 0.001; G2: -15°, p < 0.0001) and did not change in the control group. SIGNIFICANCE Results demonstrated similar increases in external tibial rotation, regardless of whether an isolated medial or combined medial and lateral surgery was performed. The control group demonstrated a similar change in external tibial rotation suggesting that hamstring lengthening surgery does not contribute to increased external tibial rotation in children with CP compared to what would be expected due to natural progression.

中文翻译：

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腿筋延长后胫骨旋转结果作为脑瘫儿童单项多级手术的一部分。

背景技术Ham绳肌延长术仍然是治疗脑性瘫痪（CP）患儿蹲伏步态的最常见手术方法。尽管矢状面膝关节运动学已显示可改善手术后效果，但尚未报道对横断面膝关节运动学的影响。考虑到内侧和外侧绳肌的动作不同，在绳肌延长后，胫骨旋转可能会发生变化。研究问题CP患儿步态行走过程中仅内侧与联合内侧和外侧绳肌延长对胫骨旋转有何影响？方法回顾性分析诊断为CP的儿童，他们接受了绳肌延长手术。这些孩子分为两组：G1（n = 18）具有孤立的内侧绳肌延长，而G2（n = 30）具有组合的内侧和外侧绳肌延长。匹配的非手术对照组（n = 15）也包括在内。术前和术后分析运动学数据。G1和G2的术前至术后结果，两组基线比较以及两组之间的结果差异进行了分析。还对对照组的随访结果进行了基线分析。结果各组胫骨外旋明显增加（G1：-10°，p <0.01； G2：-11°，p <0.001，对照组：-7.7，p <0.01），干预组之间的变化无明显差异。在两个干预组中，脚的前进角度变得更加外部（G1：-15°，p <0.001； G2：-15°，p <0。0001），并且对照组没有变化。重要性无论是否进行单独的内侧或内侧和外侧联合手术，结果均显示胫骨外部旋转的相似增加。对照组表现出类似的胫骨外部旋转变化，提示与自然进展相比，CP患儿的腿筋延长手术不会增加胫骨外部旋转。