Effect of femoral derotational osteotomy in patients with idiopathic increased femoral anteversion on joint loading and muscular demands.

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2024-08-11 eCollection Date: 2024-10-01 DOI:10.1177/18632521241269339
Nathalie Alexander, Johannes Cip, Reinald Gh Brunner, Enrico De Pieri
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Abstract

Purpose: This study aimed to analyse the effect of the femoral derotational osteotomy (FDRO) on joint kinematics, kinetics, joint and muscle forces, and muscle moments in patients with idiopathic increased femoral anteversion compared with typically developing children (TDC).

Methods: In this retrospective study, 17 patients (25 limbs, 13.2 ± 2.2 years, femoral anteversion = 49.0° ± 7.1°) were compared to nine TDC (9 limbs, 12.0 ± 3.0 years, femoral anteversion = 18.7° ± 4.1°). Gait analysis was performed 8.5 ± 7.2 months pre-surgery and 17.3 ± 5.5 months post-surgery. Joint angles, moments and forces as well as muscle forces and muscle contributions to joint moments were analysed using statistical parametric mapping.

Results: Significant improvements in kinematics (hip rotation, foot progression, knee and hip flexion) were observed pre- to post-FDRO. Joint forces remained unaltered after surgery and did not differ from TDC. Gluteus minimus and deep external rotators muscle forces decreased in mid-stance, while adductor muscle forces increased during stance post-op compared to pre-op. Due to an improved knee extension postoperatively, the rectus femoris muscle force decreased to normal values during mid- and terminal stance. Postoperatively, only the deep external rotator muscle forces differed from TDC.

Conclusions: This study showed that FDRO can restore muscle forces and muscle contributions to joint moments in addition to normal gait kinematics, while joint contact forces remain within normative ranges. This knowledge might also apply to other conditions in which pathological femoral anteversion is present.

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对特发性股骨外翻患者进行股骨外翻截骨术对关节负荷和肌肉需求的影响。
目的:本研究旨在分析股骨外翻截骨术(FDRO)对特发性股骨外翻患者与发育正常儿童(TDC)的关节运动学、动力学、关节力、肌肉力和肌肉力矩的影响:在这项回顾性研究中,17 名患者(25 肢,13.2 ± 2.2 岁,股骨内翻 = 49.0° ± 7.1°)与 9 名 TDC(9 肢,12.0 ± 3.0 岁,股骨内翻 = 18.7° ± 4.1°)进行了比较。步态分析在手术前 8.5 ± 7.2 个月和手术后 17.3 ± 5.5 个月进行。使用统计参数图分析了关节角度、力矩和力量以及肌肉力量和肌肉对关节力矩的贡献:从 FDRO 术前到术后,运动学(髋关节旋转、足前伸、膝关节和髋关节屈曲)均有明显改善。术后关节力保持不变,与 TDC 没有差异。臀小肌和深外转肌在中段站立时的肌力下降,而内收肌在术后站立时的肌力与术前相比有所增加。由于术后膝关节伸展能力得到改善,股直肌在中段和末段站立时的肌力降至正常值。术后,只有深外转肌肌力与 TDC 存在差异:这项研究表明,除了正常的步态运动学外,FDRO 还能恢复肌肉力量和肌肉对关节力矩的贡献,而关节接触力则保持在正常范围内。这些知识可能也适用于存在病理性股骨内翻的其他情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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