Grisch Domenic, Stäuble Manuela, Baumgartner Sandra, van Hedel Hubertus J A, Meyer-Heim Andreas, Dreher Thomas, Krautwurst Britta
Department of Pediatric Orthopedics, Neuroorthopedics and Traumatology, University Children's Hospital Zurich, 8032 Zurich, Switzerland.
Swiss Children's Rehab, University Children's Hospital Zurich, 8910 Affoltern am Albis, Switzerland.
Children (Basel). 2023 Feb 6;10(2):307. doi: 10.3390/children10020307.
Equinus deformity with or without concomitant drop foot is a common finding in children with unilateral spastic cerebral palsy and spastic hemiplegia of other causes. Hypothetically, these deformities may lead to pelvic retraction and hip internal rotation during gait. Orthoses are used to reduce pes equinus during gait and to restore hindfoot first contact.
We aimed to investigate whether the use of orthotic equinus correction reduces rotational hip and pelvic asymmetries.
In a retrospective study, 34 children with unilateral spastic cerebral palsy or spastic hemiplegia of other causes underwent standardized instrumented 3D gait analysis with and without orthotic equinus management. We analyzed the differences in the torsional profile during barefoot walking and while wearing orthoses, as well as investigated the influence of ankle dorsiflexion and femoral anteversion on pelvic and hip kinematics and hip kinetics.
Wearing orthoses corrected pes equinus and pelvic internal rotation at the end of the stance phase and in the swing phase compared to barefoot walking. Hip rotation and the rotational moment did not significantly change with orthoses. Orthotic management or femoral anteversion did not correlate to pelvic and hip asymmetry.
The findings indicate that the correction of the equinus by using orthoses had a variable effect on the asymmetry of the hip and pelvis and internal rotation; both appear to have a multifactorial cause that is not primarily driven by the equinus component.
伴有或不伴有垂足的马蹄足畸形在单侧痉挛性脑瘫及其他病因所致的痉挛性偏瘫患儿中很常见。据推测，这些畸形可能导致步态中骨盆后缩和髋关节内旋。矫形器用于在步态中减轻马蹄足并恢复后足先着地。
我们旨在研究使用矫正马蹄足的矫形器是否能减少髋关节和骨盆的旋转不对称。
在一项回顾性研究中，34例单侧痉挛性脑瘫或其他病因所致痉挛性偏瘫患儿接受了标准化的三维步态分析，分别在佩戴和不佩戴矫正马蹄足矫形器的情况下进行。我们分析了赤脚行走和佩戴矫形器时扭转特征的差异，并研究了踝关节背屈和股骨前倾对骨盆和髋关节运动学及髋关节动力学的影响。
与赤脚行走相比，佩戴矫形器可在站立期末期和摆动期矫正马蹄足和骨盆内旋。髋关节旋转和旋转力矩在佩戴矫形器时无显著变化。矫形器治疗或股骨前倾与骨盆和髋关节不对称无关。
研究结果表明，使用矫形器矫正马蹄足对髋关节和骨盆不对称及内旋有不同影响；两者似乎都有多种因素导致，并非主要由马蹄足因素驱动。
