引導性成長矯正手術對膝外翻患者步態之影響

Abstract

因為膝關節生長板不正常之生長而導致膝外翻為小兒骨科常見之疾病，其變形將導致發育期間膝關節或者下肢在活動時有不穩定或者疼痛之症狀。其影響膝關節變形因子可能包括遺傳、骨生長不全、佝僂症或者骨外傷。外科矯正手術可幫助其變形之膝關節達成下肢對稱、恢復正常關節軸線以及下肢關節受力之目的。引導性成長矯正手術可藉由調控生長板成長速度之不同而達成矯正變形膝關節之目的。目前對於進行引導性成長矯正手術病人的步態分析為數有限。因此本研究目的在於利用步態分析，進行功能性動作下肢運動學與動力學分析，對因雙膝膝外翻之患者於接受引導性成長矯正手術前後步態的影響，本研究假設接受引導性成長矯正手術的患者，術後會有較小的步寬，較小的膝關節、踝關節外展角度，較小的髖關節內收角度以及術後膝關節會有較大的外展力矩。希望可以詳細得知膝外翻之患者於執行引導性成長矯正手術後之效果，以提供臨床醫師手術規劃、臨床評估及復健計畫之重要依據。 研究結果顯示，對於接受引導性成長矯正手術矯正雙膝膝外翻之患者，術後步寬顯著下降，且在額狀面術後髖關節內收的角度、膝關節外展的角度皆下降；術後髖關節外展力矩、術後膝關節外展力矩皆上升，然而，踝關節在額狀面的關節角度以及下肢三個關節在矢狀面術後不論是關節角度、關節力矩都沒有明顯改善。綜合以上結論，手術對於髖關節和膝關節額狀面的關節角度和關節力矩有明顯改善，但對於踝關節在額狀面的關節角度和矢狀面的關節角度以及關節力矩卻無明顯改善，因此推測手術植入植入物時是否考量骨頭生長方向以及是否需要考量矯正踝關節以改善踝關節角度亦或小朋友尚未改變原先走路方式，需由術後復健以達到矯正目的。

Deformities of the knee joint in the children sometimes extend beyond the physiological limit to produce symptoms. Factors including family history, bone dysplasia, Blount’s disease, Rickets, fracture, and trauma would interfere with the normal angular alignment of the lower limbs. Corrective procedures for the angular deformities of the knees were needed to achieve equal limb lengths, neutral mechanical axes, and horizontal knees by skeletal maturity. The guided growth surgery which enable the hemiepiphyseal arrest to achieve the angular correction. The aims of the current study were to evaluate the performance and lower limb joint kinematics and kinetics in the patients receiving guided growth surgery for correction bilateral valgus knee. It was hoped that a complete knowledge of the general outcome and factors influencing the performance of the guided growth surgery could be established, which would be helpful for future clinical decision-making. It was hypothesis that these patients who receiving guided growth surgery would show decreased step width, lower abduction angle of knee and ankle. These patients would also show decreased adduction angle of hip and greater abductor moment of knee. The postoperative group was found displayed decreased the step width. The angle and moment of hip and knee on gait were improved in frontal plane. However, the angle and moment were not improved in sagittal plane. The angle of the ankle was not improved in frontal plane. It is suggested that the position of implant should be meticulous, the deformity of the ankle should be considerate and the patients could do exercise training to strengthen the muscle of lower limbs.