Erkula Gürkan, Demirkan Fahir, Kiliç B Alper, Kiter Esat
Department of Orthopedics and Traumatology, Pamukkale University, Faculty of Medicine, Denizli, Turkey.
J Back Musculoskelet Rehabil. 2002 Jan 1;16(2):77-81. doi: 10.3233/bmr-2002-162-305.
Hamstring shortening (HS) causes changes in the posture and walking ability in spastic children, however, there are no studies defining the abnormalities in patellar alignment in individuals with HS.Twenty-five patients with a primary complaint of anterior knee pain, having HS detected at physical examination, and 11 healthy individuals without any HS or knee discomfort as a control group are included in this study. Serial x-rays of the spine, pelvis and knee are taken and knee x-rays are evaluated for the position of the patella in both groups.In patients with Knee Extension Deficit (KED) ≥ 60°, the Blackburne-Peel ratio is lower and the Insall-Salvati ratio is higher than the other groups, denoting a cephalic location of the patella (p < 0.05). There are no changes in the congruency and sulcus angles between the HS and control groups. Vertebral and pelvic changes correlate well with the literature, confirming that significant alterations occur after 60° of KED in adults.The extensor mechanism of the knee is affected and patella is located higher than normal in patients with severe HS, which may be a cause for knee discomfort. In the light of these findings, a routine knee extension deficit examination can be suggested in the initial evaluation of knee discomfort.
腘绳肌缩短（HS）会导致痉挛性儿童的姿势和行走能力发生改变，然而，尚无研究明确HS患者髌骨关节排列的异常情况。本研究纳入了25例以膝前疼痛为主诉、体检发现有HS的患者，以及11名无HS或膝关节不适的健康个体作为对照组。对两组患者进行脊柱、骨盆和膝关节的系列X线检查，并评估膝关节X线片上髌骨的位置。在膝关节伸展不足（KED）≥60°的患者中，Blackburne-Peel比值较低，Insall-Salvati比值高于其他组，表明髌骨位置较高（p<0.05）。HS组和对照组之间的适合角和沟角没有变化。脊柱和骨盆的变化与文献报道相符，证实成人KED超过60°后会发生显著改变。严重HS患者的膝关节伸肌机制受到影响，髌骨位置高于正常，这可能是膝关节不适的原因。根据这些发现，建议在膝关节不适的初始评估中进行常规的膝关节伸展不足检查。
