Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy

被引:110
作者
DeLuca, PA [1 ]
Ounpuu, S [1 ]
Davis, RB [1 ]
Walsh, JHP [1 ]
机构
[1] Connecticut Childrens Med Ctr, Dept Orthopaed, Gait Lab, Hartford, CT 06106 USA
关键词
cerebral palsy; gait analysis; hamstring lengthening; psoas lengthening;
D O I
10.1097/00004694-199811000-00004
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
The purpose of this study was to evaluate the effects of hamstring lengthenings and psoas recessions over the brim of the pelvis (OTB) on pelvic function in the gait of patients with spastic cerebral palsy. Seventy-three patients were divided into four groups based on surgical intervention: medial hamstrings (n = 37), medial and lateral hamstrings (n = 12), medial hamstrings with psoas OTB (n = 9), and medial and lateral hamstrings with psoas OTB (n = 15). Three-dimensional gait analysis was completed both before and similar to 1 year after surgery. When pelvic position in gait was normal or posterior of normal preoperatively, there was a significant increase in pelvic tilt (p < 0.05) when medial and lateral hamstrings were lengthened, irrespective of simultaneous psoas OTB surgery. Medial hamstrings alone, with or without simultaneous psoas OTB, did not result in a significant change in pelvic position, irrespective of preoperative pelvic position. The only surgical combination that caused a reduction in excessive preoperative anterior pelvic tilt was medial and lateral hamstrings with psoas OTB, a 4 degrees change of limited clinical significance. Tn general, psoas and medial hamstring surgery have minimal effect on the pelvic position during gait. Medial and lateral hamstring lengthening will increase pelvic tilt if preoperative pelvic position is normal or slightly posteriorly tilted. The results of this study suggest that the fundamental determinants of pelvic position during gait postoperatively are the extent of hamstring surgery (medial only vs. both medial and lateral hamstring lengthening) and the preoperative position of the pelvis.
引用
收藏
页码:712 / 718
页数:7
相关论文
共 20 条
[1]  
BAUMANN JU, 1980, INT ORTHOP, V3, P305
[2]  
CHAMBERS C, 1992, DEV MED CHILD NEUROL, V34, P10
[3]   A GAIT ANALYSIS DATA-COLLECTION AND REDUCTION TECHNIQUE [J].
DAVIS, RB ;
OUNPUU, S ;
TYBURSKI, D ;
GAGE, JR .
HUMAN MOVEMENT SCIENCE, 1991, 10 (05) :575-587
[4]  
DELP SL, 1996, HUMAN MOTION ANAL CU, P114
[5]   PROXIMAL HAMSTRING RELEASE FOR KNEE FLEXION AND CROUCHED POSTURE IN CEREBRAL-PALSY [J].
DRUMMOND, DS ;
ROGALA, E ;
TEMPLETON, J ;
CRUESS, R .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1974, A 56 (08) :1598-1602
[6]  
GAGE JR, 1987, DEV MED CHILD NEUROL, V29, P159
[7]  
GAGE JR, 1990, CLIN ORTHOP RELAT R, V253, P45
[8]   HAMSTRINGS IN CEREBRAL-PALSY CROUCH GAIT [J].
HOFFINGER, SA ;
RAB, GT ;
ABOUGHAIDA, H .
JOURNAL OF PEDIATRIC ORTHOPAEDICS, 1993, 13 (06) :722-726
[9]   DISTAL HAMSTRING ELONGATION IN THE MANAGEMENT OF SPASTIC CEREBRAL-PALSY [J].
HSU, LCS ;
LI, HSY .
JOURNAL OF PEDIATRIC ORTHOPAEDICS, 1990, 10 (03) :378-381
[10]  
OUNPUU S, 1991, J PEDIATR ORTHOPED, V11, P341