Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Sungnam, Kyungki 463-707, South Korea.
J Neuroeng Rehabil. 2013 Jun 15;10:56. doi: 10.1186/1743-0003-10-56.
The relationship between torsional bony deformities and rotational gait parameters has not been sufficiently investigated. This study was to investigate the degree of contribution of torsional bony deformities to rotational gait parameters in patients with diplegic cerebral palsy (CP).
Thirty three legs from 33 consecutive ambulatory patients (average age 9.5 years, SD 6.9 years; 20 males and 13 females) with diplegic CP who underwent preoperative three dimensional gait analysis, foot radiographs, and computed tomography (CT) were included. Adjusted foot progression angle (FPA) was retrieved from gait analysis by correcting pelvic rotation from conventional FPA, which represented the rotational gait deviation of the lower extremity from the tip of the femoral head to the foot. Correlations between rotational gait parameters (FPA, adjusted FPA, average pelvic rotation, average hip rotation, and average knee rotation) and radiologic measurements (acetabular version, femoral anteversion, knee torsion, tibial torsion, and anteroposteriortalo-first metatarsal angle) were analyzed. Multiple regression analysis was performed to identify significant contributing radiographic measurements to adjusted FPA.
Adjusted FPA was significantly correlated with FPA (r=0.837, p<0.001), contralateral FPA (r=0.492, p=0.004), pelvic rotation during gait (r=-0.489, p=0.004), knee rotation during gait (r=0.376, p=0.031), and femoral anteversion (r=0.350, p=0.046). In multiple regression analysis, femoral anteversion (p=0.026) and tibial torsion (p=0.034) were found to be the significant contributing structural deformities to the adjusted FPA (R2=0.247).
Femoral anteversion and tibial torsion were found to be the significant structural deformities that could affect adjusted FPA in patients with diplegic CP. Femoral anteversion and tibial torsion could explain only 24.7% of adjusted FPA.
扭转性骨畸形与旋转步态参数之间的关系尚未得到充分研究。本研究旨在探讨扭转性骨畸形对双瘫脑瘫患者旋转步态参数的影响程度。
纳入 33 例连续门诊双瘫脑瘫患者（平均年龄 9.5 岁，标准差 6.9 岁；男性 20 例，女性 13 例）的 33 条腿，这些患者均接受了术前三维步态分析、足部 X 线片和计算机断层扫描（CT）检查。从步态分析中获取校正后的足进角（FPA），通过校正常规 FPA 中的骨盆旋转，得到代表下肢从股骨头尖端到足部的旋转步态偏差。分析旋转步态参数（FPA、校正 FPA、平均骨盆旋转、平均髋关节旋转和平均膝关节旋转）与影像学测量值（髋臼角、股骨前倾角、膝关节扭转、胫骨扭转和前-后足第一跖骨角）之间的相关性。进行多元回归分析以确定对校正 FPA 有显著影响的影像学测量值。
校正后的 FPA 与 FPA（r=0.837，p<0.001）、对侧 FPA（r=0.492，p=0.004）、步态时的骨盆旋转（r=-0.489，p=0.004）、步态时的膝关节旋转（r=0.376，p=0.031）和股骨前倾角（r=0.350，p=0.046）显著相关。多元回归分析显示，股骨前倾角（p=0.026）和胫骨扭转（p=0.034）是影响校正 FPA 的显著结构性畸形（R2=0.247）。
在双瘫脑瘫患者中，股骨前倾角和胫骨扭转被发现是影响校正 FPA 的显著结构性畸形。股骨前倾角和胫骨扭转仅能解释校正 FPA 的 24.7%。
