成骨不全症患儿的步态——关节运动学和动力学的横断面研究。
Gait in children with achondroplasia - a cross-sectional study on joint kinematics and kinetics.
机构信息
Department of Women's and Children's Health, Karolinska Institutet, Motoriklab, Q2:07, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001, Leuven, Belgium.
出版信息
BMC Musculoskelet Disord. 2022 Apr 28;23(1):397. doi: 10.1186/s12891-022-05343-4.
BACKGROUND
Children with achondroplasia have extreme short stature due to short limbs, as well as several other clinical features that may affect their gait. The purpose of this cross-sectional study was to provide a detailed description of gait in children with achondroplasia compared to age-matched controls.
METHODS
Between the years 2007 and 2010, 16 children with achondroplasia [mean age 9.6 years (range 5-16; six female)] with no previous history of orthopaedic lower limb surgery and 19 age-matched controls conducted three-dimensional (3D) gait analysis at one occasion. The gait analysis rendered pelvis and lower limb joint kinematics and kinetics, and time and distance data. Descriptive statistics, independent samples t-tests, and Fisher's exact test were used to describe the cohort including gait data and participant characteristics.
RESULTS
Children with achondroplasia had kinematic gait pattern deviations in all three planes, especially in the sagittal plane, when compared to the control group. Peak anterior pelvic tilt and peak ankle dorsiflexion were found to be increased. Increased knee flexion was noted at initial contact and again at terminal stance. During stance, children with achondroplasia had a higher peak hip abduction angle and a higher peak knee varus angle in the frontal plane. In the sagittal plane, kinetic gait pattern deviations were found at the hip, knee, and ankle, consistent with a flexion pattern. Compared to the control group, children with achondroplasia walked with reduced walking speed and step length, and increased cadence. There was no difference in walking speed when leg length was taken into account. Normalised step length and normalised cadence, on the other hand, were found to be increased in children with achondroplasia.
CONCLUSIONS
The observed gait characteristics in children with achondroplasia are related to anatomical attributes and strategies to increase step length, and hence walking speed.
背景
患有软骨发育不全症的儿童由于四肢短小而存在极端的身材矮小，以及其他可能影响步态的几个临床特征。本横断面研究的目的是详细描述与年龄匹配的对照组相比，软骨发育不全症儿童的步态。
方法
在 2007 年至 2010 年间，16 名患有软骨发育不全症的儿童（平均年龄为 9.6 岁[范围为 5-16 岁；六名女性]）没有接受过下肢矫形手术的病史，19 名年龄匹配的对照组儿童在一个场合进行了三维（3D）步态分析。步态分析呈现骨盆和下肢关节运动学和动力学以及时间和距离数据。使用描述性统计、独立样本 t 检验和 Fisher 确切检验来描述包括步态数据和参与者特征的队列。
结果
与对照组相比，患有软骨发育不全症的儿童在所有三个平面上都存在运动学步态模式偏差，尤其是在矢状面。发现前骨盆倾斜和踝关节背屈峰值增加。在初始接触和终末站立时再次发现膝关节屈曲增加。在站立期间，患有软骨发育不全症的儿童在前额平面上具有更高的髋关节外展角度峰值和更高的膝关节内翻角度峰值。在矢状面，髋关节、膝关节和踝关节的动力学步态模式偏差与屈曲模式一致。与对照组相比，患有软骨发育不全症的儿童行走速度和步长降低，步频增加。考虑到腿长后，行走速度没有差异。另一方面，发现患有软骨发育不全症的儿童的标准化步长和标准化步频增加。
结论
在软骨发育不全症儿童中观察到的步态特征与增加步长（进而增加行走速度）的解剖特征和策略有关。
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