Davids Jon R, Davis Roy B, Jameson Lisa C, Westberry David E, Hardin James W
*Shriners Hospital for Children, Sacramento, CA †Shriners Hospital for Children, Greenville ‡Department of Epidemiology and Biostatistics, Institute for Families in Society, University of South Carolina, Columbia, SC.
J Pediatr Orthop. 2014 Jun;34(4):467-73. doi: 10.1097/BPO.0000000000000173.
Intoeing gait is frequently seen in developing children, and in most cases it resolves with growth. However, persistent, extreme intoeing gait, due to increased internal tibial torsion, may disrupt gait function. At our institution, children with symptomatic intoeing gait are evaluated per a standardized protocol, which includes quantitative gait analysis. When the primary cause is increased internal tibial torsion, surgical correction by supramalleolar tibial rotational osteotomy is recommended.
The study design was a retrospective case series, with normative controls (31 children), of typically developing children with symptomatic intoeing gait who were treated by isolated supramalleolar tibial rotation osteotomy (28 children, with 45 treated extremities). Preoperative and 1-year postoperative physical examination, kinematic, kinetic, and pedobarographic data were compared. Patient-reported and parent-reported outcomes in functional and satisfaction domains were assessed by items on a 7-point questionnaire.
Internal tibial torsion, foot progression angle, and knee rotation were normalized following tibial rotation osteotomy. Compensatory external hip rotation and external knee progression angle were significantly improved but not normalized following tibial rotation osteotomy. An increased coronal plane knee varus moment was significantly decreased following surgery. Increased sagittal and transverse plane knee moments were significantly decreased but not normalized following surgery. Significant improvements were observed with respect to tripping, falling, foot/ankle pain, and knee pain following surgery.
Children with symptomatic intoeing gait because of increased internal tibial torsion have characteristic primary and compensatory kinematic gait deviations that result in increased loading about the knee during the stance phase of gait. Correction of the internal tibial torsion by rotation osteotomy improves, but does not normalize, all the kinematic and kinetic gait deviations associated with intoeing gait. The association between increased internal tibial torsion and degenerative arthritis of the knee in adults may be a consequence of longstanding increased loading of the knee joint due to the kinematic gait deviations seen with intoeing gait.
Therapeutic intervention, level III.
内八字步态在发育中的儿童中很常见，大多数情况下会随着生长而自行缓解。然而，由于胫骨内旋增加导致的持续性、严重内八字步态可能会扰乱步态功能。在我们机构，有症状的内八字步态儿童按照标准化方案进行评估，其中包括定量步态分析。当主要原因是胫骨内旋增加时，建议通过胫骨上髁旋转截骨术进行手术矫正。
本研究设计为回顾性病例系列，纳入了典型发育的有症状内八字步态儿童（28例，45个治疗肢体），并设置了正常对照组（31名儿童）。比较术前和术后1年的体格检查、运动学、动力学和足底压力数据。通过7分问卷项目评估患者报告和家长报告的功能和满意度领域的结果。
胫骨旋转截骨术后，胫骨内旋、足前进角和膝关节旋转恢复正常。胫骨旋转截骨术后，代偿性髋关节外旋和膝关节外展角明显改善但未恢复正常。冠状面膝关节内翻力矩增加在术后明显降低。矢状面和横断面膝关节力矩增加在术后明显降低但未恢复正常。术后在绊倒、跌倒、足/踝关节疼痛和膝关节疼痛方面有显著改善。
因胫骨内旋增加导致有症状内八字步态的儿童具有特征性的原发性和代偿性运动学步态偏差，这会导致步态站立期膝关节负荷增加。通过旋转截骨术矫正胫骨内旋可改善但不能使与内八字步态相关的所有运动学和动力学步态偏差恢复正常。成人胫骨内旋增加与膝关节退行性关节炎之间的关联可能是由于内八字步态中出现的运动学步态偏差导致膝关节长期负荷增加的结果。
治疗性干预，III级。
