En nuevo enfoque en el manejo de la marcha agazapada: laboratorio de análisis de la marcha, Hospital Ortopédico Infantil / New approach in the management of the crouch gait: at gait lab, Hospital Ortopédico Infantil

La marcha agazapada es una de las alteraciones más frecuentes en los pacientes con parálisis cerebral infantil, y aunque es fácilmente reconocible, tampoco ha sido claramente definida. En ella, la rodilla carece de una extensión dinámica, durante la fase de apoyo, el tobillo lo podemos encontrar en flexión plantar, dorsal o neutro, y las caderas generalmente están flexionadas y frecuentemente en rotación interna y en aducción. El presente es un estudio prospectivo, realizado en el Hospital Ortopédico Infantil, empleando los datos obtenidos del departamento de historias médicas y del laboratorio de análisis de la marcha, en el cual hemos utilizado la nueva clasificación cinemática de Michael Schwartz, Director de Bioingeniería del Laboratorio de Análisis de la Marcha del Gillette Children´s Hospital, Saint Paul, Minnesota, para sujetos que presentaban excesiva flexión de rodilla al contacto inicial. Con lo cual se obtiene 5 subtipos cinemáticas de marcha agazapada, de acuerdo a los datos obtenidos en el plano sagital, y que a la vez nos permiten saber a qué nivel se encuentran las alteraciones principales de los pacientes, proporcionándonos de esta manera una guía que nos ayude en la decisión del tratamiento a emplear y al mismo tiempo nos permite realizar una valoración post-quirúrgica

Crouch gait is one of the most frequent alterations in patients with cerebral palsy, and although it is easily recognizable, has not been clearly defined. In it, the knee lacks a dynamic extension during the stance phase, the ankle can be found in plantar flexion, dorsal or neutral, and hips are usually bent and often in internal rotation and adduction. This is a prospective study conducted at the Children's Orthopedic Hospital, using data obtained from the department of medical and gait laboratory, which we have used the new classification Schwartz Michaels kinematics, Director of Bioengineering, Laboratory of Analysis of the March of Gillette Children's Hospital, Saint Paul, Minnesota, for subjects with excessive knee flexion initial contact. Thus obtained five subtypes kinematic crouched running, according to data obtained in the sagittal plane and at the same time let us know at what level are the main changes of the patients, thereby providing a guide help us in deciding the treatment to be applied at the same time allows us to perform a post-surgical evaluation

Changes of the Muscle-tendon Lengths in a Three-dimensional Musculoskeletal Model according to the Hip Transverse Angle in Cerebral Palsy Patients with Crouch Gait / 대한정형외과학회잡지

PURPOSE: Crouch gait is one of the common pathologic gaits in children with cerebral palsy. Hamstring lengthening for alleviation of knee flexion is often considered as a first choice for the treatment of crouch gait. However, there have been a variety of reports about the lengths of the hamstring muscle. The purpose of this study was to classify the crouch gait on the transverse plane and to suggest a guide line for hamstring lengthening by analyzing the length of these muscles. MATERIALS AND METHODS: The subjects for this study were selected in ambulatory spastic diplegia patients with crouch gait. A total of sixty-two patients (124 cases) were included. The gait parameters and the muscle lengths were compared. The range of +/-1 standard deviation of the normal middle stance hip rotation was considered as the normal range. The subjects were divided into three groups as hip external rotated (group I), normal (group II) and hip internal rotated (group III) according to the hip rotation. RESULTS: The flexion of the knee and hip was the greatest in group III and dorsiflexion of the ankle was the least in group I. On comparison of moment and power on the sagittal plane, there was no significant difference among the groups. In group III, the percent lengths of the adductor, biceps femoris and gracilis muscles were increased the most, whereas the percent length of the semimembranosus was decreased the most. There was no statistical difference between groups I and II and the normal control group. CONCLUSION: Irrespective of the hip rotation, the length of the hamstring muscle in patients with crouch gait did not differ compared to that of the normal control. But if rotational osteotomy is done for the correction of the increased femoral anteversion in group III, then we should consider lengthening the semimembranosus muscle.