脑瘫青少年童年时期的运动变化:年龄和矫形手术的影响。

IF 2 4区 医学 Q2 PEDIATRICS Children-Basel Pub Date : 2024-10-15 DOI:10.3390/children11101240
Nancy Lennon, Chris Church, Daniel Wagner, Tim Niiler, John Henley, Freeman Miller, Michael Wade Shrader, Jason J Howard
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引用次数: 0

摘要

背景:步态运动异常在患有脑性瘫痪(CP)的青少年中很常见,但之前的研究并未对其在整个儿童期的纵向变化进行分析。本研究探讨了年龄和矫形手术如何影响行动不便的 CP 患者在整个儿童期的步态运动学:在这项经机构审查委员会批准的前瞻性队列研究中,招募了 17-40 个月大的痉挛性 CP(GMFCS I-III)患儿。从 4 岁到 21 岁,每隔 3 年进行一次仪器步态分析,收集以自选速度光脚行走的纵向运动学数据。按年龄分布分析了每对步态分析(间隔)之间步态轮廓评分(ΔGPS)的变化(结果:研究包括 31 名儿童(GMFCS:I [13]、II [14]、III [4])。在 5.8 ± 1.6 岁时进行了基线仪器步态分析,随后每隔 2.5 ± 1.3 年进行一次分析。对从基线到最终结果的ΔGPS进行了检查,87%的肢体得到了改善/改变;对298个ΔGPS间隔进行了分析,并将其分为非手术和手术两种。分析结果表明,手术间期与非手术间期相比,GPS改善程度更大(P = 0.0004)。在15岁组中,手术间隔的GPS改善幅度明显更大,p = 0.0063:CP患儿步态运动学的改善受年龄和矫形手术干预步态矫正时机的显著影响,10岁儿童的改善最为明显。这些结果强化了考虑矫形手术时机的重要性。
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Kinematic Changes throughout Childhood in Youth with Cerebral Palsy: Influence of Age and Orthopaedic Surgery.

Background: Abnormal gait kinematics are common in youth with cerebral palsy (CP), but prior studies have not analyzed their longitudinal change throughout childhood. This study examines how age and orthopaedic surgery influence gait kinematics throughout childhood in those with ambulatory CP.

Methods: In this institutional review board-approved prospective cohort study, children with spastic CP (GMFCS I-III) were recruited at age 17-40 months. Instrumented gait analysis was performed at 3-year intervals from age 4 to 21 years, collecting longitudinal kinematic data in bare feet at a self-selected speed. The change in Gait Profile Score (ΔGPS) between each pair of gait analyses (intervals) was analyzed by age distribution (<10, 10-15, ≥15 years) and by presence/absence of orthopaedic surgery.

Results: The study included 31 children (GMFCS: I [13], II [14], III [4]). A baseline instrumented gait analysis was performed at age 5.8 ± 1.6 years with subsequent analysis at 2.5 ± 1.3-year intervals. Examining ΔGPS from baseline to final outcome, 87% of limbs were improved/unchanged; 298 intervals of ΔGPS were analyzed and classified as nonsurgical or surgical. Analysis revealed greater GPS improvement in intervals with surgery versus intervals without (p = 0.0004). Surgical intervals had significantly greater GPS improvement in the <10- vs. >15-year-old groups, p = 0.0063.

Conclusions: Improvement in gait kinematics in children with CP is significantly influenced by age and timing of orthopaedic surgical intervention for gait correction, and was most pronounced for children <10 years old. Although surgery was associated with improved outcomes in all age groups, these improvements were significantly less for children >10 years old. These results reinforce the importance of considering the timing of orthopaedic surgery.

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来源期刊
Children-Basel
Children-Basel PEDIATRICS-
CiteScore
2.70
自引率
16.70%
发文量
1735
审稿时长
6 weeks
期刊介绍: Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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