偏瘫性脑瘫的步态模式：是时候进行新的分类了吗？

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture Pub Date : 2025-04-01 DOI:10.1016/j.gaitpost.2025.03.026

Mauro César de Morais Filho , Marcelo H. Fujino , Cátia M. Kawamura , José Augusto F. Lopes , Laís Przysiada , Maria Eduarda Antunes Silva

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引用次数: 0

摘要

背景：痉挛性偏瘫的Winters， Gage和Hicks分类（WGHC）尽管有其局限性，但已被广泛使用。本研究的目的是评估WGHC在大系列脑瘫（CP）中的可靠性。是否所有偏瘫CP患者都可以根据WGHC进行分类？方法在步态实验室数据库中对诊断为痉挛性偏瘫CP的患者进行识别。仅考虑每位患者的第一次步态分析，983例患者符合纳入标准。排除杂音患者（45例）、其他病变合并偏瘫患者（11例）以及12个月内曾接受整形手术或注射肉毒杆菌的患者（395例）。其余532名受试者按WGHC描述的4组进行分类。结果224例（42.1 %）患者未被WGHC分类，并确定了另外4组：V组（115/21.6 %）-没有WGHC中描述的改变；VI组（76/14.3 %）- WGHC III或IV，但站立和摆动时踝关节背屈正常；VII组（29/5.5 %）- WGHC II， III或IV，但在摆动期踝关节背屈正常；第八组（4/0.7 %）-站立时踝关节背屈和摇摆阶段减少，站立时髋屈增加，但膝关节活动范围正常。第六组患者年龄（14.5岁）高于其他各组（p <； 0.001）。V组的GDI（76.3）与I组（73.9）相似（p = 0.979），且高于其他组（p <； 0.001）。IV组平均骨盆不对称度（32.70）和髋关节内旋度（180）高于其他组（p <； 0.001）。第七组围产期缺氧发生率较高（33.3% %）。在本研究中，57.9 %的患者根据WGHC进行了分类，并确定了另外4种模式，从而提出了更新WGHC的建议。证据水平ii。

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Gait patterns in hemiplegic cerebral palsy: Is it time for a new classification?

Background

The Winters, Gage and Hicks classification (WGHC) for spastic hemiplegia has been widely used, despite its limitations. The purpose of this study was to evaluate the reliability of WGHC in large series of cerebral palsy (CP).

Research question

May all hemiplegic CP patients be classified according to WGHC?

Methods

Participants with the diagnosis of spastic hemiplegic CP were identified in gait laboratory database. Only the first gait analysis of each patient was considered, and 983 patients met the inclusion criteria. Individuals with mixed tone (45), other pathologies combined with hemiplegia (11) and previous orthopedic surgeries or botulinum injections within 12 months (395) were excluded. The remaining 532 subjects were classified according to the 4 groups described by WGHC.

Results

224 (42.1 %) patients were unclassified by WGHC and 4 additional groups were identified: group V (115/21.6 %)-none of the alterations described in WGHC; group VI (76/14.3 %)- WGHC III or IV, but with normal ankle dorsiflexion in stance and swing; group VII (29/5.5 %)- WGHC II, III or IV, but with normal ankle dorsiflexion in swing phase; group VIII (4/0.7 %)-reduction of ankle dorsiflexion in stance and swing phases with increased hip flexion in stance, but with normal knee range of motion. The age in group VI (14.5 years) was higher than other groups (p < 0.001). The GDI in group V (76.3) was similar (p = 0.979) to group I (73.9) and greater than other groups (p < 0.001). The mean pelvic asymmetry (32.7⁰) and internal hip rotation (18⁰) in group IV were higher than other groups (p < 0.001). The higher prevalence of perinatal anoxia (33.3 %) was observed in group VII.

Significance

In the present study, 57.9 % of patients were classified according to WGHC and 4 additional patterns were identified, leading a proposal of update at WGHC.

Level of evidence

III.

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来源期刊

Gait & posture 医学-神经科学

CiteScore

4.70

自引率

12.50%

发文量

616

审稿时长

6 months

期刊介绍： Gait & Posture is a vehicle for the publication of up-to-date basic and clinical research on all aspects of locomotion and balance. The topics covered include: Techniques for the measurement of gait and posture, and the standardization of results presentation; Studies of normal and pathological gait; Treatment of gait and postural abnormalities; Biomechanical and theoretical approaches to gait and posture; Mathematical models of joint and muscle mechanics; Neurological and musculoskeletal function in gait and posture; The evolution of upright posture and bipedal locomotion; Adaptations of carrying loads, walking on uneven surfaces, climbing stairs etc; spinal biomechanics only if they are directly related to gait and/or posture and are of general interest to our readers; The effect of aging and development on gait and posture; Psychological and cultural aspects of gait; Patient education.