Background

Pathologic gait is common in patients with cerebral palsy (CP). Single-event multilevel surgery (SEMLS) is a combination of surgical procedures to improve pathologic gait in patients with CP. However, the effect of each procedure is difficult to predict. The gait deviation index (GDI) is useful in comparing pre- and postoperative improvement.

Research question

In this study, we evaluated the degree of GDI improvement in patients with CP and analyzed factors related to surgical outcomes.

Methods

We screened patients seen between May 2003 and December 2019 via a clinical data warehouse to identify those with CP who had been followed up for >1 year and who had undergone SEMLS. The inclusion criteria were (1) CP patients with GMFCS levels I, II and III, (2) patients who underwent SEMLS, (3) and patients who underwent 3D gait analyses preoperatively and at least 1 year postoperatively. A linear mixed model was used to model GDI improvement, assess effects of covariates, and examine factors that contributed to improvement.

Results

Overall, 544 patients were included. The average improvement in overall GDI was 8.9 ± 12.3, 9.6 ± 12.0, and 6.4 ± 8.6 in Gross Motor Function Classification System (GMFCS) levels I, II, and III, respectively. In GMFCS level II patients, GDI improvement decreased by 0.26 points with a 1-year delay in surgery (p = 0.0022). Within each group of GMFCS levels, femoral derotation osteotomy (FDO) was a significant factor in GDI improvement in GMFCS levels I and II. Rectus femoris transfer (RFT) and supracondylar extension osteotomy (SCO) were significant factors in GMFCS level II. No single procedure was shown to affect improvement in GMFCS level III.

Significance

Postoperative GDI improved in all levels of GMFCS. Particular procedures especially affected postoperative improvement in GDI in levels I and II. Our data do not mean to set an indication for particular procedures; however, in GMFCS levels I, II patients, particular procedures, such as FDO, yielded a greater GDI improvement in our data set.

中文翻译：

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单次多级脑瘫患者术后GDI改善的影响因素。

背景

病理性步态在脑瘫（CP）患者中很常见。单事件多级手术（SEMLS）是外科手术程序的组合，可改善CP患者的步态。但是，每个过程的效果很难预测。步态偏差指数（GDI）可用于比较术前和术后的改善情况。

研究问题

在这项研究中，我们评估了CP患者的GDI改善程度，并分析了与手术结局相关的因素。

方法

我们通过临床数据仓库筛选了2003年5月至2019年12月之间见过的患者，以识别那些随访超过1年且接受过SEMLS的CP患者。入选标准为（1）CP级别为I，II和III的CP患者，（2）接受SEMLS的患者，（3）以及术前和术后至少1年进行3D步态分析的患者。线性混合模型用于模拟GDI改善，评估协变量的影响并检查有助于改善的因素。

结果

总共包括544名患者。总运动功能分类系统（GMFCS）的I，II和III级别的总体GDI的平均改善分别为8.9±12.3、9.6±12.0和6.4±8.6。在GMFCS II级患者中，GDI改善降低了0.26点，手术时间延迟了1年（p = 0.0022）。在每组GMFCS水平中，股骨回旋截骨术（FDO）是GMFCS I和II级GDI改善的重要因素。股直肌转移（RFT）和con上伸截骨术（SCO）是GMFCS II级的重要因素。没有显示任何单一程序会影响GMFCS III级的改善。

意义

各级GMFCS术后GDI均得到改善。特定的程序尤其影响I和II级GDI的术后改善。我们的数据并不意味着对特定程序有所指示；但是，在GMFCS I，II级患者中，某些程序（例如FDO）在我们的数据集中产生了更大的GDI改善。