Background

Flexed knee gait is a common gait dysfunction in individuals with bilateral spastic cerebral palsy (BSCP) and is often addressed with single event multilevel surgery (SEMLS). SEMLS has been shown to have positive short-term effects especially on sagittal knee joint kinematics with less knee flexion during stance phase. However, mid- and long-term observations are rare, and results are reported in discrete parameters or summary statistics where temporal aspects are not considered.

Research question

Does the improved knee joint kinematics after patellar tendon shortening (PTS) as part of SEMLS persist in the long-term in individuals with BSCP?

Methods

Data of instrumented gait analysis of twelve participants (females/males: 5/7, mean age: 15.3 ± 3.4 years) with BSCP treated with PTS as part of SEMLS were retrospectively analyzed. Participants had had follow-up gait analysis 1, 5 and 7 years or more after surgery. Three-dimensional lower extremity kinematics of walking at a self-selected speed were collected using a 12-camera motion capture system and 4 embedded force plates. One-dimensional statistical parametric mapping (SPM) was used for data analysis, permitting time point comparisons of continuous data.

Results

Time point comparison revealed no significant differences in the sagittal plane for knee joint kinematics (p > 0.05) over the tree measurement time points. Hip and ankle joint kinematics as well as normalised walking speed remained stable over the observation period.

Significance

This is the first study investigating lower extremity kinematics in patients with BSCP and flexed knee gait after SEMLS with SPM. Results demonstrate that positive effects on sagittal knee joint kinematics of PTS as part of SEMLS persist up to 9 years after surgery and progressivity does not reoccur. Thus, if clinical examination indicates an operation in individuals with BSCP, improved kinematics through SEMLS persist into adulthood. With the relatively new statistical procedure SPM gait can be displayed and analysed in established joint angle curves making them easier to understand (e.g. physiotherapists, movement scientists, physicians).

中文翻译：

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bilateral骨腱缩短后双侧痉挛性脑瘫膝关节步态弯曲的长期随访。

背景

屈膝步态是双侧痉挛性脑瘫（BSCP）患者的常见步态功能障碍，通常通过单事件多级手术（SEMLS）解决。SEMLS已被证明具有积极的短期效果，尤其是在矢状膝关节运动学上，在站立阶段膝关节屈曲较少。但是，中长期观察很少，结果以离散参数或汇总统计报告，其中不考虑时间因素。

研究问题

SCP骨肌腱缩短（PTS）作为SEMLS的一部分后，膝关节运动学的改善是否长期持续存在于BSCP患者中？

方法

回顾性分析了12名参与者（女性/男性：5/7，平均年龄：15.3±3.4岁）接受PTS作为SEMLS治疗的BSCP的仪器化步态分析数据。参与者在手术后1、5和7年或更长时间进行了步态分析。使用12台摄像机运动捕捉系统和4个嵌入式测力板，以自选速度行走的三维下肢运动学信息。一维统计参数映射（SPM）用于数据分析，允许对连续数据进行时间点比较。

结果

时间点比较显示，在树测量时间点上，膝关节运动学的矢状面没有显着差异（p> 0.05）。在观察期间，髋和踝关节运动学以及正常的步行速度保持稳定。

意义

这是第一个研究BSCP和SEMLS合并SPM后膝关节弯曲步态患者下肢运动学的研究。结果表明，作为SEMLS的一部分，对PTS矢状膝关节运动学的积极影响一直持续到手术后9年，并且没有复发。因此，如果临床检查表明患有BSCP的患者可以手术，则通过SEMLS改善的运动学一直持续到成年。使用相对较新的统计程序，可以在已建立的关节角度曲线中显示和分析SPM步态，使其更易于理解（例如，理疗师，运动科学家，医师）。