Khamis Sam, Carmeli Eli
Gait and Motion Analysis Laboratory, Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy, Faculty of Social Welfare and Health sciences, University of Haifa, Haifa, Israel.
Department of Physical Therapy, Faculty of Social Welfare and Health sciences, University of Haifa, Haifa, Israel.
Gait Posture. 2017 Sep;57:115-123. doi: 10.1016/j.gaitpost.2017.05.028. Epub 2017 May 31.
Controversy still exists as to the clinical significance of leg length discrepancy (LLD) in spite of the fact that further evidence has been emerging regarding the relationship between several clinical conditions and LLD. The objectives of our study were to review the available research with regard to LLD as a cause of clinically significant gait deviations, to determine if there is a relationship between the magnitude of LLD and the presence of gait deviations and to identify the most common gait deviations associated with LLD. In line with the PRISMA guidelines, a literature search was carried out throughout the Medline, CINAHL and EMBASE databases. Twelve articles met the predetermined inclusion criteria and were included in the review. Quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) scale was completed for all included studies. Two main methodologies were found in 4 studies evaluating gait asymmetry in patients or healthy participants with anatomic LLD and 8 studies evaluating gait deviations while simulating LLD by employing artificial lifts of 1-5cm on healthy subjects. A significant relationship was found between anatomic LLD and gait deviation. Evidence suggests that gait deviations may occur with discrepancies of >1cm, with greater impact seen as the discrepancy increases. Compensatory strategies were found to occur in both the shorter and longer limb, throughout the lower limb. As the discrepancy increases, more compensatory strategies occur. Sagittal plane deviations seem to be the most effective deviations, although, frontal plane compensations also occur in the pelvis, hip and foot.
尽管关于几种临床病症与腿长差异（LLD）之间的关系已有越来越多的证据，但LLD的临床意义仍存在争议。我们研究的目的是回顾关于LLD作为临床显著步态偏差原因的现有研究，确定LLD的程度与步态偏差的存在之间是否存在关联，并识别与LLD相关的最常见步态偏差。按照PRISMA指南，在Medline、CINAHL和EMBASE数据库中进行了文献检索。12篇文章符合预定的纳入标准并被纳入综述。对所有纳入研究使用非随机研究方法学指数（MINORS）量表完成了质量评估。在4项评估有解剖学LLD的患者或健康参与者步态不对称的研究以及8项通过在健康受试者身上使用1 - 5厘米的人工鞋垫模拟LLD来评估步态偏差的研究中发现了两种主要方法。发现解剖学LLD与步态偏差之间存在显著关联。有证据表明，当差异>1厘米时可能会出现步态偏差，且随着差异增大影响更明显。发现在较短和较长肢体的整个下肢都出现了代偿策略。随着差异增大，会出现更多的代偿策略。矢状面偏差似乎是最有效的偏差，不过，在骨盆、髋部和足部也会出现额状面代偿。
