脊髓脊膜膨出症患儿有症状和无症状肢体在步态中的运动学和动力学

Rao Smita, Dietz Fred, Yack H John

Department of Physical Therapy, New York University, New York, NY, USA.

J Pediatr Orthop. 2012 Jan-Feb;32(1):106-12. doi: 10.1097/BPO.0b013e31823b18a4.

BACKGROUND

Knee pain and early arthrosis have emerged as significant problems in young adults with myelomeningocele (MMC). The purpose of our study was to examine kinematics and kinetics during gait in symptomatic and asymptomatic limbs of children with an MMC to better understand the factors that may predispose individuals with an MMC to potentially debilitating knee problems.

METHODS

Seven children with L3-L4 level MMC and 8 age-matched typically-developing control children participated in this study. Three-dimensional kinematic and kinetic data were obtained bilaterally during gait. A custom-designed femoral tracking device, with established reliability and validity was used to track the thigh. The limbs in an MMC group were subdivided into 2 subgroups (n=6 and 8, symptomatic and asymptomatic, respectively) based on history of pain at the knee joint after walking/weight bearing activity in the last 6 months. An 1-way analysis of variance with post hoc Bonferroni adjustments was used to compare lower extremity kinematic and kinetic variables between symptomatic, asymptomatic, and control limbs. The Pearson product moment correlation (r) was used to assess the relationship between variables of interest.

RESULTS

Symptomatic limbs showed increased knee flexion in stance (P=0.01) compared with asymptomatic limbs. Symptomatic limbs showed trends toward increased knee extension, adduction, and internal rotation moments (P=0.031, P=0.025, and P=0.024, respectively) compared with asymptomatic limbs. Hip internal rotation was positively associated with knee internal rotation moment (r=0.93, P=0.008 and r=0.76, P=0.08 in symptomatic and asymptomatic limbs, respectively) and increased knee adduction moment (r=0.84, P=0.03 and r=0.91, P=0.01 in symptomatic and asymptomatic limbs, respectively).

CONCLUSIONS

Symptomatic limbs in children with an MMC showed increased knee flexion and trends toward higher extension, adduction, and internal rotation moments. Increased knee flexion accompanied by inadequate control of hip transverse kinematics may have significant implications for knee joint loading in this population.

LEVEL OF EVIDENCE

Level 4 (Case series with controls, motion laboratory gait analysis).

背景

膝关节疼痛和早期关节病已成为患有脊髓脊膜膨出（MMC）的年轻人的重要问题。我们研究的目的是检查患有MMC的儿童有症状和无症状肢体在步态中的运动学和动力学，以更好地了解可能使患有MMC的个体易患潜在致残性膝关节问题的因素。

方法

7名L3 - L4水平MMC患儿和8名年龄匹配的正常发育对照儿童参与了本研究。在步态期间双侧获取三维运动学和动力学数据。使用一种定制设计的、具有既定可靠性和有效性的股骨跟踪装置来跟踪大腿。根据过去6个月行走/负重活动后膝关节疼痛史，MMC组的肢体被细分为2个亚组（分别为n = 6和8，有症状和无症状）。采用带有事后Bonferroni校正的单因素方差分析来比较有症状、无症状和对照肢体之间的下肢运动学和动力学变量。Pearson积差相关（r）用于评估感兴趣变量之间的关系。

结果

与无症状肢体相比，有症状肢体在站立期膝关节屈曲增加（P = 0.01）。与无症状肢体相比，有症状肢体在膝关节伸展、内收和内旋力矩方面有增加的趋势（分别为P = 0.031、P = 0.025和P = 0.024）。髋关节内旋与膝关节内旋力矩呈正相关（有症状和无症状肢体中r分别为0.93，P = 0.008和r = 0.76，P = 0.08），并且与膝关节内收力矩增加相关（有症状和无症状肢体中r分别为0.84，P = 0.03和r = 0.91，P = 0.01）。