Fondation Ildys, Brest, France; LATIM, Inserm U1101, Brest, France; Université de Bretagne Occidentale, Brest, France.
LATIM, Inserm U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; Service de Médecine Physique et de Réadaptation, CHRU Brest, France.
Gait Posture. 2022 Feb;92:51-59. doi: 10.1016/j.gaitpost.2021.11.011. Epub 2021 Nov 16.
Medical and surgical interventions to prevent or reduce bone deformities and improve gait in children with cerebral palsy (CP) are based on empirical evidence that there is a relationship between bone deformities and gait deviations.
What is the relationship between tibial-femoral bone morphology and kinematic gait variables in ambulant children with CP?
A retrospective analysis was conducted on data from 121 children with uni- (n = 64, mean age 9.9 (SD 3.4) years) and bi- lateral (n = 57, mean age 10.4 (SD 3.6) years) CP who had undergone 3D gait analysis and biplanar X-rays (EOS® system). The limbs were split as DIP (the more impaired limb of children with bilateral CP), HEMI (the impaired limb of unilateral CP) and REF (the unimpaired limb of unilateral CP). Multi-variable Linear Regressions were performed between 23 kinematic variables, the Gait Deviation Index (GDI) and a model composed of nine 3D bone variables for each limb type.
When the whole sample was pooled, 72% of R values were poor, 16% were fair, and 12% were moderate. Lower limb bone morphology models explained less than 1% of GDI variability. Correlations between tibial-femoral rotational parameters and hip rotation were mostly poor. Mean foot progression angle was the only kinematic parameter that was fairly to moderately correlated with bone variables in the 3 limb types. A tibial-femoral bone model explained 48% of the variability of mean foot progression angle in the REF limbs, 31% in the HEMI limbs and 25% in the DIP limbs.
Tibial-femoral bone morphology was only weakly related to kinematic gait variables, in contrast with common clinical assumptions. These results suggest that factors other than bone morphology influence gait quality and thus a thorough clinical examination and gait analysis is required prior to making treatment decisions.
为了预防或减少脑瘫（CP）儿童的骨骼畸形和改善步态，医学和外科干预措施是基于骨骼畸形与步态偏差之间存在关联的经验证据。
在能够独立行走的 CP 儿童中，股骨-胫骨形态与运动学步态变量之间存在什么关系？
对 121 名单侧 CP（n=64，平均年龄 9.9（SD 3.4）岁）和双侧 CP（n=57，平均年龄 10.4（SD 3.6）岁）儿童的 3D 步态分析和双平面 X 射线（EOS®系统）数据进行了回顾性分析。将四肢分为 DIP（双侧 CP 中更受影响的肢体）、HEMI（单侧 CP 中受影响的肢体）和 REF（单侧 CP 中未受影响的肢体）。对每个肢体类型的 23 个运动学变量、步态偏差指数（GDI）和由 9 个 3D 骨骼变量组成的模型进行了多变量线性回归。
当汇总整个样本时，R 值的 72%较差，16%为中等，12%为良好。下肢骨骼形态模型解释了不到 1%的 GDI 变异性。股骨-胫骨旋转参数与髋关节旋转之间的相关性大多较差。平均足进路角度是 REF、HEMI 和 DIP 肢体类型中唯一一个与骨骼变量有较好到中等相关性的运动学参数。在 REF 肢体中，股骨-胫骨骨骼模型解释了平均足进路角度的 48%的变异性，在 HEMI 肢体中解释了 31%，在 DIP 肢体中解释了 25%。
股骨-胫骨形态与运动学步态变量的关系仅较弱，与常见的临床假设相反。这些结果表明，除骨骼形态外，还有其他因素影响步态质量，因此在做出治疗决策之前，需要进行全面的临床检查和步态分析。
