Petrarca M, Zaccara A, Marciano A, Della Bella G, Mosiello G, Carniel S, Gazzellini S, Capitanucci M L, De Gennaro M, Caione P, Aloi I P, Castelli E
Movement Analysis and Robotic Laboratory (MARLab) Pediatric Neuro‑Rehabilitation Division "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy -
Eur J Phys Rehabil Med. 2014 Jun;50(3):265-74. Epub 2014 Mar 21.
The role of bony pelvic anomalies in bladder exstrophy is long established and has generated many papers addressing walking problems. Biomechanical studies and kinematic gait analysis were performed on very young children.
A direct kinetic gait evaluation has never been performed, nor has the effect of pelvis dimorphism on the upper body been studied.
Controlled experimental study.
Outpatients were studied at the time of periodic follow up.
Nineteen patients with bladder exstrophy, age 14±8 years, and twenty-five healthy control participants, age 15±8 years, were enrolled in the present gait analysis study.
Clinical evaluation and standard gait analysis were performed.
Gait analysis deviations between exstrophy patients and controls and between patients that received pelvic osteotomy (OT--6 patients) and those that did not (no-OT--13 patients) were analyzed. Bladder exstrophy significantly affects kinematics and kinetics of trunk, spine, pelvis, knee and foot; in particular: in OT, trunk retroversion, pelvic retroversion and rotation, hip adduction angle and moment, knee flexion and its maximum power during loading response increased, whereas in no-OT, spine angle, pelvic posterior tilt, hip extension, and the external rotation of the foot progression angle increased. All the kinetics parameters analyzed in the study showed lower values in the patient group than in controls.
. Walking in patients with bladder exstrophy is accomplished by retroversion of the pelvis and deviations mainly in the spine angle in no-OT and in knee flexion in OT.
Gait analysis was shown to be an effective tool for the detection of walking deviations that should be identified early, prompting rehabilitative treatment in order to prevent spine and knee diseases.
骨盆异常在膀胱外翻中的作用早已明确，并且已经产生了许多关于行走问题的论文。对非常年幼的儿童进行了生物力学研究和运动步态分析。
从未进行过直接的动力学步态评估，也未研究骨盆二态性对上身的影响。
对照实验研究。
在定期随访时对门诊患者进行研究。
19名膀胱外翻患者，年龄14±8岁，以及25名健康对照参与者，年龄15±8岁，纳入了本步态分析研究。
进行了临床评估和标准步态分析。
分析了膀胱外翻患者与对照组之间以及接受骨盆截骨术的患者（OT组 - 6例患者）和未接受骨盆截骨术的患者（非OT组 - 13例患者）之间的步态分析偏差。膀胱外翻显著影响躯干、脊柱、骨盆、膝盖和足部的运动学和动力学；具体而言：在OT组中，躯干后倾、骨盆后倾和旋转、髋关节内收角度和力矩、膝关节屈曲及其在负重反应期间的最大功率增加，而在非OT组中，脊柱角度、骨盆后倾、髋关节伸展以及足前进角的外旋增加。研究中分析的所有动力学参数在患者组中的值均低于对照组。
膀胱外翻患者的行走是通过骨盆后倾以及非OT组主要在脊柱角度和OT组在膝关节屈曲方面的偏差来完成的。
步态分析被证明是检测行走偏差的有效工具，应尽早识别，促使进行康复治疗以预防脊柱和膝盖疾病。
