Objective To evaluate the effects of Achilles tendon lengthening on talipes equinus in children with spastic cerebral palsy. Methods From December, 2013 to June, 2014, seventeen spastic cerebral palsy children with talipes equinus (34 feet) received Achilles tendon lengthening. Ankle dorsiflexion range of motion (ROM) and surface electromyography from tibialis anterior and medial head of gastrocnemius were measured before and 8 to 12 months after operation, respectively. ROM of passive and active dorsiflexion, root mean square (RMS) of tibia muscle group and co-contraction ratio (CR) when standing were compared. Results The ROM of ankle passive and active dorsiflexion increased (Z>4.867, P<0.001), while the RMS of gastrocnemius muscle decreased when ankle passively dorsiflex (t=4.31, P<0.001). RMS of tibialis anterior and gastrocnemius muscle changed little when standing (Z<1.291, P>0.05), while CR reduced (t=2.38, P<0.05). Conclusion Achilles tendon lengthening can improve the coordination of tibia muscle group to increase the ROM of ankle for children with talipes equinus after spastic cerebral palsy.
FANG Ke
,
LI Fan-ling
,
XIAO Sheng
,
LI Xin
,
LIU Hong
. Effects of Achilles Tendon Lengthening on Talipes Equinus in Children with Spastic Cerebral Palsy[J]. Chinese Journal of Rehabilitation Theory and Practice, 2017
, 23(6)
: 734
-736
.
DOI: 10.3969/j.issn.1006-9771.2017.06.024
[1] Wang S, Miao S, Zhuang P, et al. Assessment of surface electromyographic clinical analysis of selective femoral neurotomy on cerebral palsy with stiff knee [J]. J Neurosci Methods, 2011, 199(1): 98-102.
[2] 陈秀洁,李树春. 小儿脑性瘫痪的定义、分型和诊断条件[J]. 中华物理医学与康复杂志, 2007, 29(5): 309-311.
[3] 向俊璐,周文智,田萍,等. 针刺推拿对痉挛型脑性瘫痪尖足的影响[J]. 中国康复理论与实践, 2015, 21(3): 334-337.
[4] Lin CL, Lin CJ, Huang MT, et al. Mesh Achilles tendon lengthening–a new method to treat equinus deformity in patients with spastic cerebral palsy: surgical technique and early results [J]. J Pediatr Orthop B, 2013, 22(1): 14-19.
[5] 张天久,俞松,杨小红,等. 跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足的疗效[J]. 实用儿科临床杂志, 2012, 27(10): 795-797.
[6] Chung CY, Sung KH, Lee KM, et al. Recurrence of equinus foot deformity after tendo-Achilles lengthening in patients with cerebral palsy [J]. J Pediatr Orthop, 2015, 35(4): 419-425.
[7] 戴明. Vulpius腱膜延长术和“Z”形跟腱延长术治疗儿童痉挛型脑瘫马蹄足畸形疗效比较[J]. 中国民康医学, 2013, 25(16): 8-11.
[8] Lyon R, Liu X, Schwab J, et al. Kinematic and kinetic evathe ankle joint before and after tendo Achilles lengthening with spastic diplegia [J]. J Pediatr Orthop, 2005, 25(4): 479-483.
[9] Krupinski M, Borowski A, Synder M. Long term follow-up of subcutaneous Achilles tendon lengthening in the treatment of spastic equinus foot in patients with cerebral palsy [J]. Ortop Traumatol Rehabil, 2015, 17(2): 155-161.
[10] Cobeljic G, Vukasinovic Z, Apostolovic M, et al. Choice of operative procedures to correct equinus deformity in patients with cerebral palsy [J]. Acta Chir Iugosl, 2006, 53(4): 21-26.
[11] 李范玲,张惠佳,李欣,等. 生长痛患儿小腿肌肉表面肌电图研究[J]. 中国康复理论与实践, 2015, 21(3): 311-314.
[12] 张梅莹,毛世刚,于洋,等. 肌电触发电刺激对脑卒中后痉挛性足下垂的影响[J]. 中国康复理论与实践, 2015, 21(3): 256-259.
[13] 张海红,王健. 双侧屈伸肘运动中主动肌与拮抗肌的表面肌电图变化[J]. 中国运动医学杂志, 2009, 28(4): 431-434.
[14] 许晶莉,范艳萍,代早荣. 表面肌电图在脑性瘫痪康复中的应用[J]. 中国康复理论与实践, 2013, 19(3): 257-260.
[15] 许晶莉,黄少昂,代早荣,等. 不同病情程度脑瘫患儿的表面肌电图特征初探[J]. 中国康复, 2013, 28(5): 354-356.
[16] Graham HK, Natrass GR, Selber PR. Re: kinematic and kinetic evaluation of the ankle joint before and after tendo Achilles lengthening in patients with spastic diplegia [J]. J Pediatr Orthop, 2007, 27(1): 104-105.
[17] Davids JR, Rogozinski BM, Hardin JW, et al. Ankle dorsiflexor function after plantar flexor surgery in children with cerebral palsy [J]. J Bone Joint Surg Am, 2011, 93(23): e1381-e1387.
[18] Lofterod B, Terjesen T. Local and distant effects of isolated calf muscle lengthening in children with cerebral palsy and equinus gait [J]. J Child Orthop, 2008, 2(1): 55-61.
[19] Kerr Graham H, Selber P. Musculoskeletal aspects of cerebral palsy [J]. J Bone Joint Surg Br, 2003, 85(2): 157-166.
