Correction of Combined Flexed and Stiff Knee Gait in Spastic Diplegic Cerebral Palsy by Double Tendon Transfers around the Knee as Part of Multilevel Surgery

Abstract

Background/Purpose: Flexed knee gait and stiff knee gait are common coexisting gait disturbances in children with cerebral palsy. We analyzed the effect of medial hamstring transfer and distal rectus transfer around the knee as part of multi-level surgery for this group of patient. Methods: Eleven lower limbs of six patients who received double transfer were retrospectively studied. Instrumented gait analysis were carried out before and a minimum of 2 years after operation. Results: Comparing the kinematic study before and after the operation, maximum knee extension in stance phase (MKES), total knee swing (TKS) and the time to maximum knee flexion in swing phase (TMKFS) showed statistically significant improvement (p <0.05). Hip extension in swing phase and hip extension power were maintained. The oxygen consumption during walking also decreased after operation (p <0.05). Conclusion: Double transfer around the knee can improve both flexed knee gait and stiff knee gait, without causing significant hip extension weakness. 中 文 摘 要 背景/目的: 彎曲膝蓋步態和僵硬膝蓋步態是腦癱兒童中常見的共存步態障礙。我們分析了用內側繩肌腱轉移 和遠端股直肌腱轉移圍繞膝蓋作為這一組病人的多層手術的一部分的影響。 方法: 回顧性分析6例接受雙轉移的患者，共有11例下肢接受手術。在手術之前和最少2年之後進行儀器化步 態分析。 結果: 比較手術前後的運動學研究，站立期最大膝伸展(Maximum knee extension in stance phase, MKES)，全膝關節擺動(Total knee swing, TKS)和擺動期最大膝關節屈曲時間(Time to maximum knee flexion in swing phase, TMKFS)顯示術後有統計學上顯著的改善(p <0.05)。擺動期中的髖關節延伸角度 和髖關節延伸能力全都得到保持。步行期間的氧消耗也在手術後減少(p <0.05