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The change in sagittal plane gait patterns from childhood to maturity in bilateral cerebral palsy
Gait & Posture ( IF 2.4 ) Pub Date : 2021-08-28 , DOI: 10.1016/j.gaitpost.2021.08.022
Bidzina Kanashvili 1 , Freeman Miller 1 , Chris Church 1 , Nancy Lennon 1 , Jason J Howard 1 , John D Henley 1 , Timothy Niiler 1 , Julieanne P Sees 1 , Kenneth J Rogers 1 , M Wade Shrader 1
Affiliation  

Background

The longitudinal stability of sagittal gait patterns in diplegic cerebral palsy (CP), stratified using the Rodda classification, is currently unknown.

Research question

What is the trajectory of sagittal plane gait deformities as defined by the Rodda classification in a large cohort treated with orthopedic surgery guided by gait analysis?

Methods

A retrospective study utilized gait analysis to evaluate sagittal gait parameters before age 8 and after age 15 years. Individual limbs were categorized at each time point according to the Rodda classification based on mean sagittal plane knee and ankle angle during stance. Welch’s t-tests compared gait variables from early childhood with maturity and examined changes associated with plantarflexor lengthening surgery.

Results

100 youth with CP were evaluated twice: at a mean age of 5.49 ± 1.18 and 19.09 ± 4.32 years, respectively. Gross Motor Function Classification System distribution at maturity was I (10.5 %), II (55.2 %), III (28.6 %), and IV (5.7 %). At the initial visit, most limbs were in either true equinus (30 %) or jump-knee gait (26.5 %). At maturity, crouch gait (52.5 %) was the most common classification, of which 47.6 % were mild (1–3 standard deviations from age-matched norm; 21°–30°) and 52.4 % moderate or severe. For the entire cohort, at initial and final visits, respectively, mean knee flexion in stance was 26.8°±14.8° and 25.9°±11.4° (p = 0.320), ankle dorsiflexion in stance increased from −0.3°±11.5° to 9.0°±6.0° (p < 0.001), and passive knee flexion contracture was −2.3°±7.0° and -3.9°±8.0° (p = 0.043). In children who started in true equinus, apparent equinus, and crouch, there was no difference in stance phase knee flexion at maturity between those who underwent plantarflexor lengthenings versus those who did not (p > 0.18).

Significance

The trend in this cohort was toward crouch with increased stance phase ankle dorsiflexion from early childhood to maturity. Plantarflexor lengthenings were not a significant factor in the progression of stance phase knee flexion.



中文翻译:

双侧脑瘫患儿从儿童到成年矢状面步态模式的变化

背景

使用 Rodda 分类分层的双侧脑瘫 (CP) 矢状步态模式的纵向稳定性目前尚不清楚。

研究问题

在步态分析指导下接受骨科手术治疗的大型队列中,Rodda 分类定义的矢状面步态畸形的轨迹是什么?

方法

一项回顾性研究利用步态分析来评估 8 岁之前和 15 岁之后的矢状步态参数。根据站立期间膝关节和踝关节平均矢状面角度的 Rodda 分类法,在每个时间点对单个肢体进行分类。Welch 的 t 检验比较了从幼儿期到成熟期的步态变量,并检查了与跖屈肌延长手术相关的变化。

结果

100 名患有 CP 的青年接受了两次评估:平均年龄分别为 5.49 ± 1.18 岁和 19.09 ± 4.32 岁。成熟时的粗大运动功能分类系统分布为 I (10.5 %)、II (55.2 %)、III (28.6 %) 和 IV (5.7 %)。在初次就诊时,大多数肢体处于真正的马蹄足 (30 %) 或跳膝步态 (26.5 %)。成熟时,蹲伏步态 (52.5%) 是最常见的分类,其中 47.6% 为轻度(与年龄匹配标准相差 1-3 个标准差;21°-30°),52.4% 为中度或重度。对于整个队列,在初次和最终就诊时,站立时的平均膝关节屈曲分别为 26.8°±14.8° 和 25.9°±11.4°(p = 0.320),站立时踝关节背屈从 -0.3°±11.5° 增加到 9.0 °±6.0° (p < 0.001),被动膝关节屈曲挛缩为 -2.3°±7.0° 和 -3.9°±8.0° (p = 0.043)。在真正的马匹开始的孩子中,

意义

该队列的趋势是蹲伏,从幼儿到成熟的站立阶段踝关节背屈增加。跖屈肌延长不是站立期膝关节屈曲进展的重要因素。

更新日期:2021-09-02
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