Bruderer-Hofstetter Marina, Fenner Verena, Payne Erika, Zdenek Katja, Klima Harry, Wegener Regina
Institute of Physiotherapy, School of Health Professions, University of Applied Sciences Zurich, Winterthur, Switzerland; Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
J Orthop Res. 2015 Feb;33(2):155-62. doi: 10.1002/jor.22746. Epub 2014 Oct 4.
Coxa antetorta describes an abnormal torsion of the femur. It is commonly considered a cosmetic problem and is treated surgically only in severe cases and the presence of physical complaints. The purpose of this study was to identify deviations in gait kinematics and kinetics in pediatric patients caused by coxa antetorta and to categorize these deviations into primary and secondary deviations. We conducted a retrospective, cross-sectional three-dimensional (3D) gait analysis study to detect gait deviations in adolescents (n = 18; age range 10.5-17.5 years) with coxa antetorta compared to age-matched healthy control subjects (n = 17). Principal component (PC) analysis was used for data reduction. Linear mixed models applied to PC-scores were used to estimate the main effects within retained PCs followed by a post-hoc subgroup analysis. Patients walked with smaller external foot progression angle, greater knee adduction, more internally rotated and flexed hips and greater anterior pelvic tilt. Subgroup analysis revealed that-depending on knee alignment-patients had higher knee and hip adduction moments. These deviations in joint kinematics and kinetics may be associated with physical complaints and accelerated development of osteoarthritis. Assessment of gait deviations related to coxa antetorta using 3D gait analysis may be an additional tool in individual clinical decision-making.
股前扭髋描述了一种股骨的异常扭转。它通常被认为是一个外观问题，仅在严重病例且存在身体不适时才进行手术治疗。本研究的目的是确定股前扭髋患儿步态运动学和动力学的偏差，并将这些偏差分为原发性和继发性偏差。我们进行了一项回顾性横断面三维（3D）步态分析研究，以检测与年龄匹配的健康对照受试者（n = 17）相比，患有股前扭髋的青少年（n = 18；年龄范围10.5 - 17.5岁）的步态偏差。主成分（PC）分析用于数据降维。应用于PC分数的线性混合模型用于估计保留的主成分内的主要效应，随后进行事后亚组分析。患者行走时外展足进展角较小；膝关节内收较大；髋关节更多地内旋和屈曲；骨盆前倾较大。亚组分析显示，根据膝关节对线情况，患者的膝关节和髋关节内收力矩更高。这些关节运动学和动力学的偏差可能与身体不适和骨关节炎的加速发展有关。使用3D步态分析评估与股前扭髋相关的步态偏差可能是个体临床决策中的一个额外工具。
