Fairburn P S, Panagamuwa B, Falkonakis A, Osborne S, Palmer R, Johnson B, Southwood T R
Clinical Measurements Laboratory, West Midlands Rehabilitation Centre, UK.
Arch Dis Child. 2002 Aug;87(2):160-5. doi: 10.1136/adc.87.2.160.
It is difficult to identify the range of gait deviations associated with juvenile idiopathic arthritis (JIA) using simple clinical observations.
To use objective gait analysis to accurately describe biomechanical gait abnormalities in JIA and to search for common patterns, which may subsequently serve as a basis for therapeutic intervention.
Children with persistent polyarticular arthritis and symmetrical joint involvement were referred to the Gait Analysis Laboratory and independently assessed by a multidisciplinary team. Gait analysis was performed using an in-house Visual Vector System and the Novel PEDAR in-shoe plantar pressure measurement system. Clinical groupings were based on the extent of joint restriction: minimal (group A), and moderate-severe (with supinatory foot deformity (group B), or with pronatory foot deformity (group C)). Gait analysis enabled classification of each subject into one of four gait patterns: either near normal (pattern I) or one of three adaptive patterns defined by the predominant abnormality--lower limb pain (pattern II), lower limb deformity (pattern III), or a combination of pain and deformity of the lower limb (pattern IV).
Of the 15 subjects assessed as part of this study, seven were placed into clinical group A, six into group B, and two into group C. All the subjects with gait patterns I and II were found in clinical group A. Both subjects from clinical group C exhibited gait pattern III. All subjects from clinical group B and the remainder from group A exhibited a mixture of gait patterns III and IV.
Despite the initial clinical observations it was not always possible to predict the resultant gait pattern. Scientific gait analysis allowed a clear distinction to be made between primary and secondary gait deviations, and accurate targeting of physiotherapy and orthotic interventions to suit each individual. Prospective quantitative analysis in a larger sample is under way to support the clinical effectiveness of these findings.
通过简单的临床观察很难确定与幼年特发性关节炎（JIA）相关的步态偏差范围。
运用客观步态分析准确描述JIA患者的生物力学步态异常，并寻找常见模式，以便为后续治疗干预提供依据。
患有持续性多关节关节炎且关节受累对称的儿童被转介至步态分析实验室，由多学科团队进行独立评估。使用内部视觉矢量系统和新型PEDAR鞋垫式足底压力测量系统进行步态分析。临床分组基于关节受限程度：轻度（A组）、中度至重度（伴有内翻足畸形（B组）或外翻足畸形（C组））。步态分析可将每个受试者分为四种步态模式之一：接近正常（模式I）或由主要异常定义的三种适应性模式之一——下肢疼痛（模式II）、下肢畸形（模式III）或下肢疼痛与畸形并存（模式IV）。
在本研究评估的15名受试者中，7名被归入临床A组，6名归入B组，2名归入C组。所有步态模式为I和II的受试者均在临床A组。临床C组的两名受试者均表现出步态模式III。临床B组的所有受试者以及A组的其余受试者均表现出步态模式III和IV的混合。
尽管有初步临床观察，但并非总能预测最终的步态模式。科学的步态分析能够明确区分原发性和继发性步态偏差，并准确针对每个个体进行物理治疗和矫形干预。正在对更大样本进行前瞻性定量分析，以支持这些发现的临床有效性。
