脑瘫患者的膝关节疼痛与髌股症状

Knee Pain and Patellofemoral Symptoms in Patients With Cerebral Palsy.

作者信息

Rethlefsen Susan A, Nguyen Danny T, Wren Tishya A L, Milewski Matthew D, Kay Robert M

机构信息

*Children's Orthopaedic Center, Children's Hospital †Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA ‡Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, CT.

出版信息

J Pediatr Orthop. 2015 Jul-Aug;35(5):519-22. doi: 10.1097/BPO.0000000000000304.

DOI:10.1097/BPO.0000000000000304

PMID:25171680

Abstract

BACKGROUND

Knee pain in cerebral palsy (CP) is associated with increased patellofemoral forces present when walking with flexed knees. In typically developing children, knee pain and patellofemoral dysfunction are associated with obesity, genu valgum, femoral anteversion, and external tibial torsion. These problems are also common in CP, and may contribute to knee problems in this population. The purposes of this study were to define the prevalence of knee pain and patellofemoral dysfunction in children with CP, and to identify physical and gait characteristics (using 3-dimensional gait analysis data) that predispose them to such problems.

METHODS

Retrospective review of 121 children with CP, Gross Motor Function Classification System level I to IV, who underwent computerized gait analysis testing. Demographics, range of motion, body mass index and hip, knee, and ankle kinematics were compared between subjects with and without knee pain.

RESULTS

Twenty-five of 121 subjects (21%) reported knee pain at the time of testing. Three of 121 subjects (2%) had a history of patellar subluxation/dislocation. Age and sex were significantly related to presence of knee pain. The likelihood of knee pain was almost 5 times higher in females (odds ratio=4.9, [95% confidence interval, 1.8-13.3], P=0.002), with a prevalence of 40% (17/42) in females versus 10% (8/79) in males. The likelihood of knee pain increased with age by approximately 13% per year (odds ratio=1.13, [95% confidence interval, 1.00-1.28], P=0.058). Malignant malalignment syndrome showed a potential relationship to more severe knee pain (P=0.05), which warrants further investigation. Body mass index, pes valgus, and degree of stance knee flexion showed no statistically significant relationships to knee pain (P>0.16).

CONCLUSIONS

The prevalence of knee pain in ambulatory patients with CP is approximately 21%. Patellar subluxation (2%) and dislocation are rare in these patients. Knee pain is not always related to crouch, femoral anteversion, external tibial torsion, genu valgum, or pes valgus. Knee pain in these patients is more prevalent in females, and increases with increasing age.

LEVEL OF EVIDENCE

Level III-case-control study.

摘要

背景

脑性瘫痪（CP）患者的膝关节疼痛与屈膝行走时髌股关节受力增加有关。在正常发育的儿童中，膝关节疼痛和髌股关节功能障碍与肥胖、膝外翻、股骨前倾和胫骨外旋有关。这些问题在CP患者中也很常见，可能是导致该人群膝关节问题的原因。本研究的目的是确定CP患儿膝关节疼痛和髌股关节功能障碍的患病率，并确定使其易患此类问题的身体和步态特征（使用三维步态分析数据）。

方法

对121例CP患儿（粗大运动功能分类系统I至IV级）进行回顾性研究，这些患儿均接受了计算机化步态分析测试。比较了有膝关节疼痛和无膝关节疼痛的受试者的人口统计学特征、活动范围、体重指数以及髋、膝和踝关节的运动学数据。

结果

121例受试者中有25例（21%）在测试时报告有膝关节疼痛。121例受试者中有3例（2%）有髌骨半脱位/脱位史。年龄和性别与膝关节疼痛的存在显著相关。女性膝关节疼痛的可能性几乎是男性的5倍（优势比=4.9，[95%置信区间，1.8 - 13.3]，P = 0.002），女性患病率为40%（17/42），男性为10%（8/79）。膝关节疼痛的可能性随年龄增长每年增加约13%（优势比=1.13，[95%置信区间，1.00 - 1.28]，P = 0.058）。严重畸形综合征与更严重的膝关节疼痛存在潜在关系（P = 0.05），这值得进一步研究。体重指数、扁平足和站立时膝关节屈曲程度与膝关节疼痛无统计学显著关系（P>0.16）。