小儿脊柱侧凸的功能性腿长差异:颅颈交界处错位引起的可逆神经肌肉补偿

Brunette Jean, Gélinas Luc, Chankowsky Jeffrey
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引用次数: 1

摘要

背景:在文献中,腿长差异(LLD)和骨盆倾斜常与脊柱侧凸相关,神经肌肉的贡献也被提到可能参与其中。本文假设颅颈交界处(CCJ)错位(CCJM)可能诱发神经肌肉失衡,导致功能性腿长差异,而重新建立正确的对齐可导致部分LLD消失。方法:对40例7 ~ 16岁、15 ~ 50 Cobb角的脊柱侧凸儿童进行连续随访,平均随访16个月。表现出CCJM体征和症状的儿童通过特定的x线片进行评估。确认不对齐的患者接受CCJ调整以重新对齐。结果:所有患者均首次出现LLD和CCJM。从首次就诊时平均LLD为11.0 mm (Pre)开始,重新排列后(平均15天)第一次随访时LLD平均减少90% (1.1 mm),整个随访期间的平均LLD (2.0 mm)比平均LLD前减少82%,平均每位患者每年1.2次CCJM复发和治疗。结论:结果提示脊柱侧凸儿童的LLD与CCJM之间存在关联,并且LLD可以通过CCJ的重新排列来逆转,并且可以持续。偶尔的CCJM复发通常是由于跌倒或撞击。在水平位置测量LLD。很可能在一个垂直的重力位置,迫使脚甚至在地面上,这些神经肌肉不平衡力负责这种LLD不会消失,而是转化为其他盆腔和脊柱代偿性偏差,这可能有助于脊柱侧凸的发展。
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Functional Leg Length Discrepancy among Pediatric Scoliosis: A Reversible Neuromuscular Compensation from Craniocervical Junction Misalignment
Background: Leg length discrepancy (LLD) and pelvic obliquity have often been associated with scoliosis in the literature, and neuromuscular contributions have been mentioned as being possibly involved. It is herein hypothesized that a craniocervical junction (CCJ) misalignment (CCJM) may induce a neuromuscular imbalance leading to functional leg length discrepancy, and that re-establishing a proper alignment can result in some LLD disappearance. Methods: A total of n = 40 consecutive scoliotic children aged 7-16 years, 15-50 Cobb angle, were followed for a mean period of 16 months. Children presenting signs and symptoms of CCJM were evaluated with specific radiographs. Patients for whom the misalignment was confirmed received a CCJ adjustment for their re-alignment. Results: All patients presented at first LLD and CCJM. From a mean LLD of 11.0 mm at first presentation (Pre), there was a mean 90% reduction of LLD at the first follow-up visit (1.1 mm) after the re-alignment (mean 15 days Post), and the mean LLD during the complete follow-up period (2.0 mm) was 82% less than that of the mean Pre-LLD, with a mean yearly 1.2 CCJM recurrences and treatments per patient. Conclusion: The results suggest an association between LLD and CCJM among scoliotic children, and LLD may be reversed by means of a CCJ re-alignment which can be sustained. Occasional CCJM recurrences were typically due to falls or hits. The LLD were measured in a horizontal position. It is likely that in a vertical gravitational position, forcing the feet even on the ground, these neuromuscular imbalance forces responsible for this LLD would not disappear but translate into other pelvic and spinal compensatory deviations that may possibly contribute to the development of scoliosis.
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