Sass Pamela, Hassan Ghinwa
Department of Family Practice, State University of New York-Downstate Medical Center, Brooklyn, New York 11203, USA.
Am Fam Physician. 2003 Aug 1;68(3):461-8.
Rotational and angular problems are two types of lower extremity abnormalities common in children. Rotational problems include intoeing and out-toeing. Intoeing is caused by one of three types of deformity: metatarsus adductus, internal tibial torsion, and increased femoral anteversion. Out-toeing is less common than intoeing, and its causes are similar but opposite to those of intoeing. These include femoral retroversion and external tibial torsion. Angular problems include bowlegs and knock-knees. An accurate diagnosis can be made with careful history and physical examination, which includes torsional profile (a four-component composite of measurements of the lower extremities). Charts of normal values and values with two standard deviations for each component of the torsional profile are available. In most cases, the abnormality improves with time. A careful physical examination, explanation of the natural history, and serial measurements are usually reassuring to the parents. Treatment is usually conservative. Special shoes, cast, or braces are rarely beneficial and have no proven efficacy. Surgery is reserved for older children with deformity from three to four standard deviations from the normal.
旋转和角度问题是儿童常见的两种下肢异常类型。旋转问题包括内八字和外八字。内八字由三种畸形之一引起：跖骨内收、胫骨内旋和股骨前倾增加。外八字比内八字少见，其病因相似但与内八字相反。这些包括股骨后倾和胫骨外旋。角度问题包括膝内翻和膝外翻。通过仔细的病史询问和体格检查可以做出准确的诊断，其中包括扭转轮廓（下肢测量的四部分综合指标）。有扭转轮廓各部分的正常值图表以及两个标准差范围的值。在大多数情况下，异常会随着时间改善。仔细的体格检查、对自然病程的解释以及系列测量通常会让家长放心。治疗通常是保守的。特殊鞋子、石膏或支具很少有益，且未证实有疗效。手术仅适用于畸形程度比正常超出三到四个标准差的大龄儿童。
