Article

In children with spastic diplegia, hip extension in terminal stance
is limited by retraction of the psoas muscle, which decreases stride propulsion
and step length on the contralateral side. Whether intramuscular psoas
lengthening (IMPL) is effective remains controversial.
The objective of this
study was to assess the impact of IMPL as a component of single-event multi-level
surgery (SEMLS) on spatial and temporal gait parameters, clinical hip flexion
deformity, and hip flexion kinematics. HYPOTHESIS: IMPL as part of SEMLS does not
significantly improve hip flexion kinematics. MATERIALS AND METHODS: A
retrospective review was conducted of the medical charts of consecutive
ambulatory children with cerebral palsy who had clinical hip flexion deformity
(>10 degrees ) with more than 10 degrees of excess hip flexion in terminal stance
and who underwent SEMLS. The groups with and without IMPL were compared.
Preoperative values of the clinical hip flexion contracture, hip flexion
kinematics in terminal stance, and spatial and temporal gait parameters were
compared to the values recorded after a mean postoperative follow-up of 2.4+/-2.0
years (range, 1.0-8.7 years). Follow-up was longer than 3 years in 6 patients.
RESULTS: Of 47 lower limbs (in 34 patients) included in the analysis, 15 were
managed with IMPL. There were no significant between-group differences at
baseline. Surgery was followed in all limbs by significant decreases in kinematic
hip flexion and in the Gillette Gait Index. In the IMPL group, significant
improvements occurred in clinical hip flexion deformity, walking speed, and step
length. The improvement in kinematic hip extension was not significantly
different between the two groups. Crouch gait recurred in 3 (8%) patients.
DISCUSSION: The improvement in kinematic hip extension in terminal stance was not
significantly influenced by IMPL but was, instead, chiefly dependent on improved
knee extension and on the position of the ground reaction vector after SEMLS.
IMPL remains indicated only when the clinical hip flexion deformity exceeds 20
degrees . LEVEL OF EVIDENCE: IV, retrospective study.
CI - Copyright (c) 2016. Published by Elsevier Masson SAS.

Langue : FRANCAIS