Department of Orthopaedics and Traumatology, İstanbul School of Medicine, İstanbul University, Istanbul, Turkey.
Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, İstanbul Kültür University, Istanbul, Turkey.
Int Orthop. 2024 Oct;48(10):2661-2671. doi: 10.1007/s00264-024-06263-9. Epub 2024 Aug 7.
This study aimed to analyze and compare gait patterns and deviations at long-term follow-up in children who received medial open reduction (MOR) before 18 months for unilateral or bilateral hip developmental dysplasia (DDH).
A retrospective chart review was conducted on children who underwent MOR. The study population was divided into two groups: the unilateral group, including unilateral (five children with unilateral) and bilateral (five children with bilateral DDH). Ten healthy children were recruited for the control group. Spatiotemporal, kinematic, stiff-knee gait (SKG), and kinetic gait characteristics were analyzed.
Stance time was significantly shorter in both the unilateral (median [IQR]; 590 ms, [560.0-612.5] and bilateral (575 ms, [550-637.5]) groups than in the control group (650, [602.5-677.5]) (p < 0.001), whereas swing time did not differ substantially (p = 0.065) There was no considerable difference in the mean knee flexion at swing between the unilateral (31.6°, [30-36]) and control (30.11°, [27.8-33.6] groups (p > 0.05), but the bilateral group (28.5°, [24.9-32.1]) showed the lower values than the other groups (p < 0.001 for bilateral vs unilateral group; p = 0.008 bilateral vs unilateral group). All the SKG parameters significantly differed among the groups in multi-group comparisons (p < 0.001 for each parameter). Three children had borderline SKG, and two had not-stiff limbs in the unilateral group. In the bilateral group, four children had stiff limbs, and one had borderline SKG. Most kinetic gait parameters were not statistically different between groups (p > 0.05).
This study has revealed notable deviations in gait patterns of children with DDH treated by MOR at long-term follow-up compared to healthy children's gait. MOR could negatively affect pelvic motion during gait due to impaired functions of the iliopsoas and adductor muscles, and SKG can be encountered secondary to iliopsoas weakness.
本研究旨在分析和比较在 18 个月前接受内侧切开复位术（MOR）治疗的单侧或双侧髋关节发育性脱位（DDH）儿童的长期随访时的步态模式和偏差。
对接受 MOR 的儿童进行回顾性图表审查。研究人群分为两组：单侧组，包括单侧（5 名单侧）和双侧（5 名双侧 DDH）；对照组包括 10 名健康儿童。分析了时空、运动学、僵硬膝步态（SKG）和动力学步态特征。
单侧组（中位数[IQR]；590ms，[560.0-612.5]和双侧组（575ms，[550-637.5]）的站立时间明显短于对照组（650ms，[602.5-677.5]）（p<0.001），而摆动时间差异不大（p=0.065）。单侧组（31.6°，[30-36]）和对照组（30.11°，[27.8-33.6]）的摆动时平均膝关节屈曲差异不大（p>0.05），但双侧组（28.5°，[24.9-32.1]）的数值低于其他组（双侧与单侧组比较，p<0.001；双侧与单侧组比较，p=0.008）。在多组比较中，所有 SKG 参数在组间差异均有统计学意义（p<0.001 ）。单侧组有 3 例边界性 SKG，2 例非僵硬肢体；双侧组有 4 例僵硬肢体，1 例边界性 SKG。大多数动力学步态参数在组间无统计学差异（p>0.05）。
与健康儿童的步态相比，接受 MOR 治疗的 DDH 儿童在长期随访时的步态模式存在明显偏差。MOR 可能会由于髂腰肌和内收肌功能受损而对步态时的骨盆运动产生负面影响，并且可能会出现 SKG 是由于髂腰肌无力引起的。
