股骨远端短缩截骨及髌韧带下移治疗脑瘫蹲伏步态的临床疗效

Efficacy of Combined Distal Femoral Shortening Osteotomy and Patellar Tendon Advancement for Crouch Gait in Cerebral Palsy

摘要: 目的：探讨股骨远端短缩截骨(distal femoral shortening osteotomy, DFSO)联合髌韧带下移(patellar tendon advancement, PTA)术治疗脑性瘫痪患者重度膝关节屈曲挛缩和蹲伏步态的临床疗效及安全性。方法：回顾分析2019年11月至2025年10月期间在我中心接受DFSO联合PTA手术的22例脑瘫患儿的临床资料。所有患者均为粗大运动功能分级(Gross Motor Function Classification System, GMFCS) III级，手术时年龄(13.41 ± 2.79)岁，男13例，女9例。比较术前与术后膝关节屈曲角度、骨盆前倾角及步态运动学参数变化，并分析角度改善与临床因素的相关性。平均随访时间58.5个月。结果：术后站立期膝关节最大伸展度平均提高25.21˚ (P < 0.001)，骨盆前倾角平均增加7.83˚ (P < 0.05)。角度改善幅度与术前屈曲角度呈正相关，与术后残余角度呈负相关。步态偏离指数(Gait Deviation Index, GDI)及时空参数较术前改善趋势未达统计学显著水平。随访期间未出现骨不连、神经损伤等严重并发症。结论：DFSO联合PTA术能有效矫正重度膝关节屈曲挛缩，改善膝伸展功能并减轻骨盆前倾代偿，术式安全可行。手术医师应关注术后骨盆姿态变化并加强康复训练，以优化长期步态恢复。

Abstract: Objective: To investigate the clinical efficacy and safety of distal femoral shortening osteotomy (DFSO) combined with patellar tendon advancement (PTA) in the treatment of severe knee flexion contracture and crouch gait in patients with cerebral palsy. Methods: A retrospective analysis was conducted on the clinical data of 22 children with cerebral palsy who underwent DFSO combined with PTA at our center between November 2019 and October 2025. All patients were classified as Gross Motor Function Classification System (GMFCS) level III, with a mean operative age of 13.41 ± 2.79 years, including 13 males and 9 females. Preoperative and postoperative knee flexion angle, pelvic tilt angle, and gait kinematic parameters were compared. The correlation between angle improvement and clinical factors was analyzed. The mean follow-up period was 58.5 months. Results: Postoperatively, the maximum knee extension during the stance phase improved by an average of 25.21˚ (P < 0.001), with an average increase of 7.83˚ in the pelvic tilt angle (P < 0.05). The magnitude of angle improvement was positively correlated with the preoperative flexion angle and negatively correlated with the postoperative residual angle. Improvement trends in the Gait Deviation Index (GDI) and spatiotemporal parameters were observed but did not reach statistical significance. No serious complications such as nonunion or nerve injury occurred during the follow-up period. Conclusions: DFSO combined with PTA effectively corrects severe knee flexion contracture, improves knee extension function, and reduces compensatory pelvic anterior tilt. The procedure is safe and feasible. Surgeons should pay attention to postoperative pelvic posture changes and reinforce rehabilitation training to optimize long-term gait recovery.