Liu Raymond W, Xie Katherine K
Division of Pediatric Orthopaedic Surgery, Case Western Reserve University, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, RBC 6081, Cleveland, OH 44106 USA.
HSS J. 2016 Oct;12(3):245-249. doi: 10.1007/s11420-016-9506-8. Epub 2016 Jun 3.
It is unclear whether isolated gastroc/soleus tightness can increase the risk of lower extremity injury in an otherwise healthy child.
QUESTIONS/PURPOSES: (1) Is there a difference in gastroc/soleus tightness, as represented by ankle dorsiflexion with the knee extended, in children presenting with upper versus lower extremity complaints? (2) Is there a difference in gastroc/soleus tightness in children presenting with atraumatic versus traumatic lower extremity complaints?
We performed a cross-sectional study of 206 consecutive walking age children presenting to a county orthopedic clinic with new upper or lower extremity complaints. Passive ankle dorsiflexion was measured based on the lateral border of the foot versus the anterior lower leg with the knee fully extended and the foot in inversion.
Average age was 10.0 ± 4.5 years. In the 117 patients presenting with upper extremity complaints, ankle dorsiflexion was 15.0° ± 11.6°. Of the lower extremity patients, 40 presented without trauma, with dorsiflexion of 11.8° ± 14.5°, while 49 presented with trauma, with dorsiflexion of 6.5° ± 12.0°. Multiple regression analysis found significantly decreased ankle dorsiflexion with increasing age and in the lower extremity trauma group. Twelve percent of upper extremity patients had 0° or less of dorsiflexion, as compared to 25% of lower extremity nontrauma patients and 41% of lower extremity trauma patients.
Patients presenting with lower extremity trauma had significantly more gastroc/soleus tightness in their well leg than patients presenting with upper extremity complaints. Gastroc/soleus tightness may present a simple target for reducing lower extremity injury rates in children.
目前尚不清楚单纯的小腿三头肌/比目鱼肌紧张是否会增加健康儿童下肢受伤的风险。
问题/目的：（1）以伸直膝关节时的踝关节背屈来表示，上肢与下肢有症状的儿童在小腿三头肌/比目鱼肌紧张程度上是否存在差异？（2）无创伤性与创伤性下肢有症状的儿童在小腿三头肌/比目鱼肌紧张程度上是否存在差异？
我们对连续206名前来县骨科诊所就诊、有新的上肢或下肢症状的步行年龄儿童进行了横断面研究。在膝关节完全伸直且足内翻的情况下，根据足的外侧缘与小腿前侧之间的距离测量被动踝关节背屈。
平均年龄为10.0±4.5岁。在117名有上肢症状的患者中，踝关节背屈为15.0°±11.6°。在下肢患者中，40名无创伤，背屈为11.8°±14.5°，而49名有创伤，背屈为6.5°±12.0°。多元回归分析发现，随着年龄增长以及在下肢创伤组中，踝关节背屈显著降低。12%的上肢患者背屈为0°或更小，相比之下，下肢无创伤患者为25%，下肢创伤患者为41%。
与有上肢症状的患者相比，有下肢创伤的患者患侧小腿三头肌/比目鱼肌紧张程度明显更高。小腿三头肌/比目鱼肌紧张可能是降低儿童下肢受伤率的一个简单目标。
