Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, Switzerland.
Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
J Biomech. 2019 Mar 27;86:167-174. doi: 10.1016/j.jbiomech.2019.02.005. Epub 2019 Feb 16.
Increased femoral antetorsion leads to several gait deviations, and amongst others, an increased knee flexion was reported in mid and terminal stance. Therefore, the purpose of this retrospective study was to identify gait deviations caused by increased femoral antetorsion and to perform subgroup analyses based on sagittal knee kinematics. Patients with isolated, CT confirmed increased femoral antetorsion (n = 42) and age-matched typically developing children (TDC, n = 17) were included in this study. Patients were referred to gait analysis because of gait abnormalities going along with an increased femoral antetorsion ≥30°. Kinematic and kinetic data were recorded during 3D gait analysis and three valid gait cycles were analyzed. Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the group effect of PC-scores of retained PCs explaining 90% of the cumulative variance. Group effects of PC-scores revealed that patients walked with more flexed hips and greater anterior pelvic tilt throughout the gait cycle. Knee flexion was increased in patients during mid and terminal stance. Increased frontal plane knee and hip joint moments were found for patients compared to TDC. Furthermore, dividing patients into two subgroups based on their sagittal knee kinematics showed that kinematic gait deviations were more pronounced in patients with higher femoral antetorsion, while deviations in joint moments were more pronounced in patients with lower femoral antetorsion. Increased femoral antetorsion showed alterations in all lower limb joints and may be not only a cosmetic problem. Therefore, 3D gait analysis should be used for clinical management and operative treatment should be considered depending on severity of gait deviations.
股骨前扭转增加会导致几种步态偏差,其中报告在中间和终末站立时膝关节屈曲增加。因此,本回顾性研究的目的是确定股骨前扭转增加引起的步态偏差,并根据矢状面膝关节运动学进行亚组分析。本研究纳入了 42 例 CT 证实的孤立性、股骨前扭转增加(病例组)和年龄匹配的正常发育儿童(对照组)。患者因股骨前扭转增加≥30°导致的步态异常而被转诊至步态分析。在三维步态分析期间记录运动学和动力学数据,并分析三个有效的步态周期。使用主成分(PC)分析进行数据转换。使用线性混合模型估计保留的 PC 的 PC 分数的组效应,这些 PC 分数解释了 90%的累积方差。PC 分数的组效应表明,患者在整个步态周期中髋关节弯曲更多,骨盆前倾更大。患者在中间和终末站立时膝关节屈曲增加。与对照组相比,患者的膝关节和髋关节在额状面的关节力矩增加。此外,根据患者的矢状面膝关节运动学将患者分为两个亚组,结果显示,高股骨前扭转患者的运动学步态偏差更明显,而低股骨前扭转患者的关节力矩偏差更明显。股骨前扭转增加会改变所有下肢关节,可能不仅仅是一个美容问题。因此,应使用 3D 步态分析进行临床管理,根据步态偏差的严重程度考虑手术治疗。