Bilateral Femoral Derotatioal Osteotomy in Spastic Diplegia: Outcome Assessment of Single Stage Multilevel Surgery / 대한정형외과학회잡지

PURPOSE: To evaluate the outcome of multilevel surgery including femoral derotational osteotomy, and analyze the effect of bilateral femoral derotational osteotomy on the gait of spastic diplegia. MATERIALS AND METHODS: The medical records of 26 spastic diplegics, who had undergone a bilateral intertrochanteric femoral derotational osteotomy, bilateral distal hamstring lengthening, bilateral rectus femoris transfer, and bilateral heel cord lengthening, were evaluated. There were 16 boys and 10 girls with a mean age of 7.6 years. The pre- and post-operative gait analysis, functional assessment score, and physical examination were archived and analyzed. RESULTS: In the physical examination, the femoral anteversion, hip flexion contracture, and popliteal angle decreased significantly, while the ankle range of dorsiflexion increased significantly. In three dimensional gait analysis, the cadence remained constant while the walking speed improved significantly. In transverse plane kinematics, the mean pelvic rotation did not show any difference but foot progression angle fell into the normal range after surgery. In the sagittal plane, the maximal hip extension and H3 power generation improved significantly, while the mean anterior pelvic tilt decreased significantly. The functional assessment score improved from 7 to 9, which was significant. CONCLUSION: The walking ability of spastic diplegia with in-toeing, stiff knee and tip toeing gait improved after single stage multilevel surgery including a femoral derotational osteotomy. Femoral derotation osteotomy without psoas lengthening improved the anterior pelvic tilt despite the distal hamstring lengthening

Gait Patterns According to the Transverse Plane Deformities in Spastic Diplegia: A Preliminary Report / 대한정형외과학회잡지

PURPOSE: To understand the relationship between the gait patterns in transverse plane and the transverse plane deformities. MATERIALS AND METHODS: We evaluated the clinical, radiological, and three-dimensional gait analysis data of 152 spastic diplegics with transverse plane deformities. We define the transverse plane deformities as follows: 1) femoral anteversion > or =30 degrees, 2) thigh foot angle or =25 degrees, 3) severe foot deformities that could affect the foot progression angle. RESULTS: We classified gait patterns of spastic diplegics into 6 groups on the base of pelvic compensation and foot progression angle, and divided anatomic characteristics into symmetric and asymmetric type. Among the gait patterns, pattern I-A (in-toeing with pelvic compensation) and II-A (in-toeing without pelvic compensation) were most prevalent. Femoral antetorsion was the most frequent torsional deformities, whereas valgus of foot was second most. CONCLUSION: We classified the gait patterns and analyzed the relationship between each gait pattern and types of torsional deformities.

Gait Patterns According to the Torsional Deformities in Spastic Hemiplegia: A Preliminary Report / 대한정형외과학회잡지

PURPOSE: To understand the relationship between the gait patterns in transverse plane and the torsional deformities (TD). MATERIALS AND METHODS: We evaluated the clinical, radiological, and three-dimensional gait analysis data of 55 spastic hemiplegics with TD. We define the TD as follows: 1) femoral anteversion > or =30degrees, 2) thigh foot angle or =25degrees, 3) severe foot deformities that could affect the foot progression angle (FPA). RESULTS: There were 35 males and 20 females with an average age of 8.4 years. 49 patients (89.1%) showed pelvic compensation (PC). In the PC group, 27 patients (55.1%) showed physiologic FPA. However, 22 patients (44.9%) still showed in-toeing (19 patients) or out-toeing (3 patients) gait. Out of the 6 patients (10.9%) who did not showed PC, we could observe in-toeing, out-toeing gait, and physiologic FPA from 3, 2, and 1 patients, respectively. 51 patients (92.7%) had increased femoral anteversion. There were 11 patients (19.6%) with an internal (2 patients) or an external tibial torsion (9 patients), and 30 patients (54.5%) with foot deformities. CONCLUSION: We classified the gait patterns and analyzed the relationship between each gait pattern and types of torsional deformities.