Kim Ha Yong, Cha Yong Han, Byun Jae Yong, Chun Young Sub, Choy Won Sik
Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.
J Pediatr Orthop B. 2018 May;27(3):194-199. doi: 10.1097/BPB.0000000000000467.
Medial femoral torsion (MFT) is a common pathologic gait in cerebral palsy (CP) children that can be corrected by femoral derotational osteotomy (FDO). It is not clearly known as to how much various gait parameters change after FDO. The aim of this study was to quantify changes in gait parameters after FDO. The study group included 19 young CP patients (28 limbs, age<20 years, average age: 13.2 years) with symptomatic MFT, treated with distal FDO. The study group was divided into two groups: the unilateral FDO group (UG) and the bilateral FDO group (BG). The mean degree of derotation was 24.6° (25.0° for UG, 24.4° for BG). Pre-FDO and post-FDO values of Staheli's rotational profiles and kinematic data were compared. A paired t-test and Pearson's correlation were used for statistical analysis. The mean internal hip rotation was 71.4±6.9° before surgery and 48.6±10.7° after surgery in the UG (P<0.05) and it was 63.8±15.8° before surgery and 40.9±9.2° after FDO in the BG (P<0.05). The change in the foot progression angle (FPA) was 12.9° in the UG group (P<0.05) and 12.6° in the BG group (P<0.05). The degree of FPA had changed by about a half of the surgical derotation angle. Changes in the mean hip rotation during gait were 14.8° in the UG (P<0.05) and 6.7° in the BG (P<0.05) groups. The overall pelvic rotation was not changed after surgery. However, in patients with preoperative compensatory pelvic rotation of more than 5°, there was a change of 5.3±4.8° in the UG and 6.6±1.54° in the BG after surgery (P<0.05). There was also a trend showing that the younger the patient, the more the pelvic rotation changed (P=0.069). In-toeing gait because of MFT improved with FDO in CP patients. The expected degree of postoperative correction of FPA and hip rotation is about a half of the FDO degree. The degree of compensatory pelvic rotation should be considered to determine the correction angle of FDO, especially in young patients with preoperative pelvic rotation of more than 5°.
股骨干内侧扭转（MFT）是脑瘫（CP）患儿常见的病理性步态，可通过股骨旋转截骨术（FDO）进行矫正。目前尚不清楚FDO术后各种步态参数会有多大变化。本研究的目的是量化FDO术后步态参数的变化。研究组包括19例有症状性MFT的年轻CP患者（28条肢体，年龄<20岁，平均年龄：13.2岁），接受了远端FDO治疗。研究组分为两组：单侧FDO组（UG）和双侧FDO组（BG）。平均旋转度数为24.6°（UG为25.0°，BG为24.4°）。比较了FDO术前和术后Staheli旋转轮廓和运动学数据的值。采用配对t检验和Pearson相关性分析进行统计分析。UG组术前平均髋关节内旋为71.4±6.9°，术后为48.6±10.7°（P<0.05）；BG组术前为63.8±15.8°，FDO术后为40.9±9.2°（P<0.05）。UG组足前进角（FPA）变化为12.9°（P<0.05），BG组为12.6°（P<0.05）。FPA的变化程度约为手术旋转角度的一半。UG组步态中平均髋关节旋转变化为14.8°（P<0.05），BG组为6.7°（P<0.05）。术后总体骨盆旋转未改变。然而，术前代偿性骨盆旋转超过5°的患者，UG组术后变化为5.3±4.8°，BG组为6.6±1.54°（P<0.05）。还有一种趋势表明，患者年龄越小，骨盆旋转变化越大（P=0.069）。CP患者因MFT导致的内八字步态通过FDO得到改善。FPA和髋关节旋转的术后预期矫正程度约为FDO度数的一半。确定FDO的矫正角度时应考虑代偿性骨盆旋转程度，尤其是术前骨盆旋转超过5°的年轻患者。
