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- Title
儿童痉挛型脑性瘫痪蹲伏步态多学科团队治疗的初步经验.
- Authors
章燕云; 蔡海清; 王志刚; 徐纯鑫; 陆洋阳; 陈岑; 沈敏; 金晟
- Abstract
Objective To summarize the preliminary experiences of multidisciplinary team (MDT) treating crouch gait in spastic cerebral palsy (CP) children. Methods From June 2018 to January 2020, a total of 29 children with spastic CP with crouch gait were recruited. There were 20 boys and 9 girls with an average age of 14.3(12-16.5) years. After three-dimensional gait analysis, treatment protocols were formulated jointly by orthopedic surgeons, gait analysis technicians and rehab therapists. Preoperative rehabilitation education and rehabilitation training were provided for 3-4 weeks (including family rehabilitation 1-3 weeks).Also position placement, position transfer, wheelchair training and strength training were offered. Single event multi-level operations were performed, including hip reconstruction, patellar tendon advancement, shortening extension osteotomy of distal femur and Mosca procedure for flat valgus foot. At 2 weeks post-operation, hospital rehabilitation continued for 8 weeks. Home rehabilitation training and online instructions were offered for 10 months. Outpatient re-evaluation was performed every 3 months post-operation and three-dimensional gait analysis at 12 months after evaluating clinical efficacy. Results Twenty-nine children with spastic cerebral palsy with crouch gait completed the MDT treatment program. Time of hospital rehabilitation training and rehabilitation instruction was (0.5-2) weeks and time of family rehabilitation training lasted 2-3 weeks. Family rehabilitation training instruction was completed online. Single event multi-level operations were performed, including patellar tendon advancement (n=29), distal femoral shortening stretch (n=20), adductor release (n=10), rectus lengthening (n=1), iliopsoas release (n=15), Dega pelvic osteotomy with proximal femur derotation osteotomy (n=3), hamstring lengthening (n=14), talonavicular joint reduction with subtalar joint arthrodesis (n=5) and Mosca procedure (n=13).The mean time of postoperative 3D gait analysis was 13.5(12-15) months. The results showed that the maximum extension angle of the postoperative hip joint in the middle and end of the support phase was improved by 12.29° on average, the flexion angle of the knee joint in the mid-support phase was improved by 26.84° on average, and the dorsiflexion angle of the ankle joint in the mid-support phase was improved by 7.05° on average. The rehabilitation assessment demonstrated that the strength of hip abduction, hip extension, knee extension and ankle plantar flexor was significantly improved, and the balance stability was enhanced compared with that before surgery, but the trunk lateral displacement was not improved during walking. Conclusion In children with spastic cerebral palsy, MDT treatment for crouch gait showed promising results by effectively improving knee stiffness, enhancing muscle strength of lower extremities and correcting abnormal gait appearance. Therefore a combination of orthopedic and rehabilitation therapy for crouch gait in children with spastic cerebral palsy has an excellent short-term efficacy. However, MDT mode should be further observed for long-term outcomes.
- Publication
Journal of Clinical Pediatric Surgery, 2022, Issue 6, p516
- ISSN
1671-6353
- Publication type
Academic Journal
- DOI
10.3760/cma.j.cn101785-202202050-004