Angelico Fabiola, Freslier Marie, Romkes Jacqueline, Brunner Reinald, Schmid Stefan
University of Basel Children's Hospital, Laboratory for Movement Analysis, Basel, Switzerland; Zurich University of Applied Sciences, School of Health Professions, Winterthur, Switzerland.
University of Basel Children's Hospital, Laboratory for Movement Analysis, Basel, Switzerland.
Gait Posture. 2017 Mar;53:115-120. doi: 10.1016/j.gaitpost.2017.01.003. Epub 2017 Jan 4.
Depending on the extent of a structural leg length discrepancy (LLD), several compensatory mechanisms take place in order to maintain function and to optimize energy consumption during gait. However, studies describing the influence of a structural LLD on upper limb motion are lacking. The current study therefore aimed at the evaluation of upper limb motion during gait in LLD patients compared to healthy controls.
Motion capture data from 14 patients with structural LLD and 15 healthy controls that were collected during barefoot walking at a self-selected speed were retrospectively analyzed. Specifically, kinematic parameters of the shoulder and elbow joints as well as the trunk segment were investigated and considered in relation to a minimal clinically important difference of 5°.
The shoulders in LLD patients were kept constantly in a more extended and at initial contact in a more adducted position as compared to healthy controls. In addition, the patients' elbow joints showed increased flexion motion and the trunk segment indicated a constant trunk lateral-flexion and axial rotation tendency towards the affected side.
Patients with structural LLD indicated clinically relevant secondary deviations in shoulder and elbow motion. While some of these deviations were most likely passive physical effects, others might have occurred as active strategies to maintain balance or to regulate total body angular momentum. These findings contribute to the understanding of secondary gait deviations induced by a structural LLD and might serve as a basis for further investigations using complex musculoskeletal models.
根据结构性下肢长度差异（LLD）的程度，会出现几种代偿机制，以维持步态中的功能并优化能量消耗。然而，缺乏描述结构性LLD对上肢运动影响的研究。因此，本研究旨在评估LLD患者与健康对照者在步态中的上肢运动。
回顾性分析了14例结构性LLD患者和15名健康对照者在自选速度下赤脚行走时收集的运动捕捉数据。具体而言，研究并考虑了肩、肘关节以及躯干节段的运动学参数与5°的最小临床重要差异的关系。
与健康对照者相比，LLD患者的肩部在整个过程中保持更伸展的状态，在初始接触时处于更内收的位置。此外，患者的肘关节显示出更大的屈曲运动，并且躯干节段表现出持续向患侧的躯干侧屈和轴向旋转倾向。
结构性LLD患者在肩、肘运动方面存在临床相关的继发性偏差。虽然其中一些偏差很可能是被动的物理效应，但其他偏差可能是作为维持平衡或调节全身角动量的主动策略而出现的。这些发现有助于理解结构性LLD引起的继发性步态偏差，并可能为使用复杂肌肉骨骼模型的进一步研究提供基础。
