Crouch gait, or flexed knee gait, represents a common gait pattern in patients with spastic bilateral cerebral palsy (CP). Distal femoral extension and/or shortening osteotomy (DFEO/DFSO) and patellar tendon advancement (PTA) can be considered as viable options when knee flexion contractures are involved. Better outcomes have been reported after a combination of both, independently of the presence of knee extensor lag. In this study, we evaluated the clinical and kinematic outcomes of these procedures. We reviewed a cohort of 52 limbs (28 patients) who were treated for crouch gait by DFEO/DFSO alone (group 1, n = 15) or DFEO/DFSO + PTA (group 2, n = 37) as a part of single event multilevel surgery (SEMLS). The mean age at surgery was 14 years, and the mean follow-up time was 18 months. The physical examination data and three-dimensional standardized gait analysis were collected and analyzed before the surgery and postoperatively. Overall knee range of motion improved in all limbs. The knee flexion decreased significantly in both groups at initial, mid, and terminal stance. Hip flexion significantly decreased in mid-stance for limbs in group 2. Both clinical and gait parameters were most improved in limbs who underwent DFEO/DFSO + PTA. Increased pelvic tilt was observed in both groups after surgery. Although DFEO/DFSO alone was successful in correcting knee flexion contractures, PTA has helped to improve knee extensor lag and knee extension during gait. Therapeutic level IV

中文翻译：

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股骨远端截骨联合髌腱推进术治疗双侧痉挛性脑瘫患者蹲伏步态

蹲伏步态或屈膝步态是痉挛性双侧脑瘫 (CP) 患者常见的步态模式。当涉及膝关节屈曲挛缩时，股骨远端延长和/或缩短截骨术（DFEO/DFSO）和髌腱前移（PTA）可被视为可行的选择。据报道，两者结合后有更好的结果，与膝关节伸肌滞后的存在无关。在这项研究中，我们评估了这些手术的临床和运动学结果。我们回顾了 52 条肢体（28 名患者）的队列，这些患者仅接受 DFEO/DFSO（第 1 组，n = 15）或 DFEO/DFSO + PTA（第 2 组，n = 37）治疗蹲伏步态，作为单一事件的一部分多层次手术（SEMLS）。手术时的平均年龄为 14 岁，平均随访时间为 18 个月。术前、术后收集并分析体检数据和三维标准化步态分析。所有四肢的膝盖整体运动范围均得到改善。两组患者的膝关节屈曲度在初始、中期和最终姿势时均显着下降。第 2 组肢体在中间站立时髋部屈曲显着下降。接受 DFEO/DFSO + PTA 的肢体的临床和步态参数均得到最大改善。术后两组均观察到骨盆倾斜度增加。虽然单独使用 DFEO/DFSO 可以成功矫正膝关节屈曲挛缩，但 PTA 有助于改善步态过程中的膝关节伸肌滞后和膝关节伸展。治疗IV级