三维步态分析技术在儿骨科临床应用研究进展
|
摘要
当前三维步态分析技术作为步态和运动异常患者疾病诊断、治疗方案制定、评估疗效的精准、量化的手段,在医学临床尤其是儿骨科临床发挥着尤其重要的作用。本文主要综述了三维步态分析证据可以使脑瘫、马蹄内翻足等患儿得到更优化的干预方案,如指导巴氯酚泵疗法(ITB)、选择性脊神经背根切断术(SDR)等治疗手段的选择以及明确矫形支具适配的适应证等。国内在应用步态分析技术影响手术决策以及评价疗效方面起步较晚,该项技术的使用更多地集中在非手术疗法干预的效果评价方面。
The three-dimensional gait analysis plays a significant role to evaluate gait disorder in diagnosis, decision-making, result assessment in clinical setting, especially for pediatric orthopedic surgeons. This article reviews the studies that gait analysis provide precise evidence to make the patients with cerebral palsy or clubfoot receive more optimal interventions, such as selective dorsal rhizotomy, baclofen pump therapy as well as adaptation for orthosis and prosthetics. However, the gait analysis in China is late start for surgical decision making, mostly used for evaluation of the result of the non-surgical therapy intervention.
The three-dimensional gait analysis plays a significant role to evaluate gait disorder in diagnosis, decision-making, result assessment in clinical setting, especially for pediatric orthopedic surgeons. This article reviews the studies that gait analysis provide precise evidence to make the patients with cerebral palsy or clubfoot receive more optimal interventions, such as selective dorsal rhizotomy, baclofen pump therapy as well as adaptation for orthosis and prosthetics. However, the gait analysis in China is late start for surgical decision making, mostly used for evaluation of the result of the non-surgical therapy intervention.
引文
[1]Saunders JBM,Verne TI,Howard DE.The major determinants in normal and pathological gait[J].J Bone Joint Surg Am,1953,35(3):543-558.
[2]Perry J.Normal and pathologic gait.Atlas of orthotics[M].2nd ed.St.Louis:C.V.Mosby Co,1985.
[3]Sutherland DH,Olshen R,Cooper L,et al.The development of mature gait[J].J Bone Joint Surg Am,1980,62:336-353.
[4]Helen AB,Shylie M,Dominic The wlis foot orthoses for adults with flexible pes planus:a systematic review[J].J Foot Ankle Research,2014,7(1):23.
[5]Gage GR.Gait analysis for decision-making in cerebral palsy[J].Bull Hosp Jt Dis Orthop Inst,1983,43(2):147-163.
[6]Davids JR,Bagley AM.Identification of common gait disruption patterns in children with cerebral palsy[J].J Am Acad Orthop Surg,2014,22:782-790.
[7]James RG,Michael HS,Steven EK,et al.The identification and treatment of gait problems in cerebral pasly[M].2nd edition,Mac Keith Press,2009:P624.
[8]姜淑云,沈敏.脑瘫-全面的看护指南[M].上海:上海科技出版社,2015.
[9]陆奕昊,姜淑云.脑瘫儿童步行过程中下肢生物力学特征[J].应用物理,2015,5(12):209-215.
[10]Tishya ALW,Norman YO,Richard EB,et al.Outcomes of lower extremity orthopedic surgery in ambulatory children with cerebral palsy with and without gait analysis:results of a randomized controlled trial[J].Gait Posture,2013,38:236-241.
[11]Freeman M,Kirk D,Michael A.Cerebral palsy[M].Springer Science Business Media,2005.
[12]Shuyun J,Nancy L,Freeman M,et al.Gait evaluation before and after intrathecal baclofen therapy:a 6-year follow-up case study[C].17th Annual Meeting of the GCMAS,in Grand Rapids,Michigan,USA,2012:5.
[13]Yaszay B,Scannell BP,Bomar JD,et al.Although inconvenient,baclofen pumps do not complicate scoliosis surgery in patients with cerebral palsy[J].Spine,2015,40(8):504-509.
[14]Zachary FL,Matthew SD,Scott LD,et al.How tibiofemoral alignment and contact locations affect predictions of medial and lateral tibiofemoral contact forces[J].J Biomechanics,2015,48:644-650.
[15]Pauline G,Massimo S,Thor FB,et al.Subject-specific knee joint geometry improves predictions of medial tibiofemoral contact forces[J].J Biomechanics,2013,46:2778-2786.
[16]Allison SA,May QL,Michael HS,et al.The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait[J].Gait Posture,2006,23(3):273-281.
[17]Ferrari A,Brunner R,Faccioli S,et al.Gait analysis contribution to problems identification and surgical planning in CP patients:an agreement study[J].Eur J Phys Rehabil Med,2015,51(1):39-48.
[18]Roberts A,Stewart C,Freeman R.Gait analysis to guide a selective dorsal rhizotomy program[J].Gait Posture,2015,42(1):16-22.
[19]Langerak NG,Lamberts RP,Fieggen AG,et al.A prospective gait analysis study in patients with diplegic cerebral palsy 20 years after selective dorsal rhizotomy[J].J Neurosurg Pediatr,2008,1(3):180-186.
[20]Feger MA,Lunsford CD,Sauer LD,et al.Comparative effects of multilevel muscle tendon surgery,osteotomies,and dorsal rhizotomy on functional and gait outcome measures for children with cerebral palsy[J].Pm R,2014,7(5):485-493.
[21]Rumberg F,Bakir MS,Taylor WR,et al.The effects of selective dorsal rhizotomy on balance and symmetry of gait in children with cerebral palsy[J].Plos One,2016,11(4):221-223.
[22]James RG.Treatment of Gait problems in cerebral palsy[M].Mac Keith Press,2004.
[23]Borton DC,Walker K,Pirpiris M,et al.Isolated calf lengthening in cerebral palsy.Outcome analysis of risk factors[J].J Bone Joint Surg Br,2001,83B:364-370.
[24]Robert MK,Susan AR,James AR,et al.Outcome of gastrocnemius recession and tendo-achilles lengthening in ambulatory children with cerebral palsy[J].J Pediatr Orthop,2004,13(1):92-98.
[25]Gottschalk HP,Lori AK,Kelly AJ.Gait analysis of children treated for moderate clubfoot with physical therapy versus the ponseti cast technique[J].J Pediatr Orthop,2010,30:235-239.
[26]Karol LA,O’Brien SE,Wilson H,et al.Gait analysis in children with severe clubfeet:early results of physiotherapy versus surgical release[J].J Pediatr Orthop,2005,25:236-240.
[27]Wudbhav NS,Susan AR,Jennifer W,et al.The recurrent clubfoot:can gait analysis help us make better preoperative decisions[J].Clin Orthop,2009,467(5):1214-1222.
[28]Opheim A,Mcginley JL,Olsson E,et al.Walking deterioration and gait analysis in adults with spastic bilateral cerebral palsy[J].Gait Posture,2013,37(2):165-171.
[29]于江龙,买尔阿芭,木塔力甫·努热合买提,等.双侧痉挛型脑瘫患儿选择性脊神经后根切断术术前及术后步态特征[J].中华实验外科杂志,2015,32(5):761-764.
[30]Rebecca FM,Trevor BB,Colin ED.Combined effects of a valgus knee brace and lateral wedge foot orthotic on the external knee adduction moment in patients with varus gonarthrosis[J].Archives Physical Med Rehabil,2013,94:103-112.
[31]Peter AS,Sahar H,Adam G,et al.Brace evaluation in children with diplegic cerebral palsy with a jump gait[J].J Bone Joint Surg Am,2009,91:356-365.
[32]Munteanu SE,Scott LA,Bonanno DR,et al.Effectiveness of cus-tomised foot orthoses for Achilles tendinopathy:a randomised controlled trial[J].Br J Sports Med,2014,49(15):989.
[33]Hiroaki H,Brian SB,Hyun JK,et al.Amputee locomotion:lower extremity loading using running-specific prostheses[J].Gait Posture,2014,39(1):386-390.
[34]黄斌,姜淑云,孙武权,等.脑瘫步态特征及治疗[J].辽宁中医药大学学报,2013,15(9):127-129.
[35]胡玲,陈玉霞,王志娇,等.基于三维步态分析的个性化康复治疗对脑性瘫痪患儿步行功能的影响[J].中华物理医学与康复杂志,2012,34(4):268-271.
[2]Perry J.Normal and pathologic gait.Atlas of orthotics[M].2nd ed.St.Louis:C.V.Mosby Co,1985.
[3]Sutherland DH,Olshen R,Cooper L,et al.The development of mature gait[J].J Bone Joint Surg Am,1980,62:336-353.
[4]Helen AB,Shylie M,Dominic The wlis foot orthoses for adults with flexible pes planus:a systematic review[J].J Foot Ankle Research,2014,7(1):23.
[5]Gage GR.Gait analysis for decision-making in cerebral palsy[J].Bull Hosp Jt Dis Orthop Inst,1983,43(2):147-163.
[6]Davids JR,Bagley AM.Identification of common gait disruption patterns in children with cerebral palsy[J].J Am Acad Orthop Surg,2014,22:782-790.
[7]James RG,Michael HS,Steven EK,et al.The identification and treatment of gait problems in cerebral pasly[M].2nd edition,Mac Keith Press,2009:P624.
[8]姜淑云,沈敏.脑瘫-全面的看护指南[M].上海:上海科技出版社,2015.
[9]陆奕昊,姜淑云.脑瘫儿童步行过程中下肢生物力学特征[J].应用物理,2015,5(12):209-215.
[10]Tishya ALW,Norman YO,Richard EB,et al.Outcomes of lower extremity orthopedic surgery in ambulatory children with cerebral palsy with and without gait analysis:results of a randomized controlled trial[J].Gait Posture,2013,38:236-241.
[11]Freeman M,Kirk D,Michael A.Cerebral palsy[M].Springer Science Business Media,2005.
[12]Shuyun J,Nancy L,Freeman M,et al.Gait evaluation before and after intrathecal baclofen therapy:a 6-year follow-up case study[C].17th Annual Meeting of the GCMAS,in Grand Rapids,Michigan,USA,2012:5.
[13]Yaszay B,Scannell BP,Bomar JD,et al.Although inconvenient,baclofen pumps do not complicate scoliosis surgery in patients with cerebral palsy[J].Spine,2015,40(8):504-509.
[14]Zachary FL,Matthew SD,Scott LD,et al.How tibiofemoral alignment and contact locations affect predictions of medial and lateral tibiofemoral contact forces[J].J Biomechanics,2015,48:644-650.
[15]Pauline G,Massimo S,Thor FB,et al.Subject-specific knee joint geometry improves predictions of medial tibiofemoral contact forces[J].J Biomechanics,2013,46:2778-2786.
[16]Allison SA,May QL,Michael HS,et al.The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait[J].Gait Posture,2006,23(3):273-281.
[17]Ferrari A,Brunner R,Faccioli S,et al.Gait analysis contribution to problems identification and surgical planning in CP patients:an agreement study[J].Eur J Phys Rehabil Med,2015,51(1):39-48.
[18]Roberts A,Stewart C,Freeman R.Gait analysis to guide a selective dorsal rhizotomy program[J].Gait Posture,2015,42(1):16-22.
[19]Langerak NG,Lamberts RP,Fieggen AG,et al.A prospective gait analysis study in patients with diplegic cerebral palsy 20 years after selective dorsal rhizotomy[J].J Neurosurg Pediatr,2008,1(3):180-186.
[20]Feger MA,Lunsford CD,Sauer LD,et al.Comparative effects of multilevel muscle tendon surgery,osteotomies,and dorsal rhizotomy on functional and gait outcome measures for children with cerebral palsy[J].Pm R,2014,7(5):485-493.
[21]Rumberg F,Bakir MS,Taylor WR,et al.The effects of selective dorsal rhizotomy on balance and symmetry of gait in children with cerebral palsy[J].Plos One,2016,11(4):221-223.
[22]James RG.Treatment of Gait problems in cerebral palsy[M].Mac Keith Press,2004.
[23]Borton DC,Walker K,Pirpiris M,et al.Isolated calf lengthening in cerebral palsy.Outcome analysis of risk factors[J].J Bone Joint Surg Br,2001,83B:364-370.
[24]Robert MK,Susan AR,James AR,et al.Outcome of gastrocnemius recession and tendo-achilles lengthening in ambulatory children with cerebral palsy[J].J Pediatr Orthop,2004,13(1):92-98.
[25]Gottschalk HP,Lori AK,Kelly AJ.Gait analysis of children treated for moderate clubfoot with physical therapy versus the ponseti cast technique[J].J Pediatr Orthop,2010,30:235-239.
[26]Karol LA,O’Brien SE,Wilson H,et al.Gait analysis in children with severe clubfeet:early results of physiotherapy versus surgical release[J].J Pediatr Orthop,2005,25:236-240.
[27]Wudbhav NS,Susan AR,Jennifer W,et al.The recurrent clubfoot:can gait analysis help us make better preoperative decisions[J].Clin Orthop,2009,467(5):1214-1222.
[28]Opheim A,Mcginley JL,Olsson E,et al.Walking deterioration and gait analysis in adults with spastic bilateral cerebral palsy[J].Gait Posture,2013,37(2):165-171.
[29]于江龙,买尔阿芭,木塔力甫·努热合买提,等.双侧痉挛型脑瘫患儿选择性脊神经后根切断术术前及术后步态特征[J].中华实验外科杂志,2015,32(5):761-764.
[30]Rebecca FM,Trevor BB,Colin ED.Combined effects of a valgus knee brace and lateral wedge foot orthotic on the external knee adduction moment in patients with varus gonarthrosis[J].Archives Physical Med Rehabil,2013,94:103-112.
[31]Peter AS,Sahar H,Adam G,et al.Brace evaluation in children with diplegic cerebral palsy with a jump gait[J].J Bone Joint Surg Am,2009,91:356-365.
[32]Munteanu SE,Scott LA,Bonanno DR,et al.Effectiveness of cus-tomised foot orthoses for Achilles tendinopathy:a randomised controlled trial[J].Br J Sports Med,2014,49(15):989.
[33]Hiroaki H,Brian SB,Hyun JK,et al.Amputee locomotion:lower extremity loading using running-specific prostheses[J].Gait Posture,2014,39(1):386-390.
[34]黄斌,姜淑云,孙武权,等.脑瘫步态特征及治疗[J].辽宁中医药大学学报,2013,15(9):127-129.
[35]胡玲,陈玉霞,王志娇,等.基于三维步态分析的个性化康复治疗对脑性瘫痪患儿步行功能的影响[J].中华物理医学与康复杂志,2012,34(4):268-271.