Background

Even in mild unilateral cerebral palsy increased internal hip rotation can be noted on physical- and gait examination. The influence of spasticity on femoral growth in the transverse plane is not clear. These deviations and asymmetry in movement pattern may negatively affect efficiency of gait and cause psychological concerns about appearance.

Research question

Is increased internal hip rotation on the involved side in mild unilateral CP common and is there compensatory external pelvic rotation to keep foot progression symmetrical?

Methods

This prospective study included 45 individuals with unilateral cerebral palsy, mean age 17.7 (13.0−24.0) years. All were Gross Motor Function Classification Level I. Physical examination, three-dimensional gait analysis and magnetic resonance imaging for assessment of rotational alignment was performed.

Results

On physical examination internal hip rotation was mean 50.6 (SD 10.4) degrees on the involved side and 44.3 (SD 10.3) on the non-involved side, p = 0.001.

In gait analysis calculating the whole gait cycle, internal hip rotation was mean 2.3 (6.2) degrees on the involved side, and on the non-involved side external 1.8 (7.6) degrees, p = 0.004.

Increased external pelvic rotation was noted on the involved side, mean 2.0 (4.3) degrees with corresponding internal rotation on the non-involved side, mean 3.6 (4.4), p = 0.001. There was no difference in foot progression, p = 0.067, with mean 5.1 (8.6) and 3.9 (6.4) external respectively.

Magnetic resonance imaging revealed femoral torsion on the involved side mean 17.3 (11.3) degrees compared to 11.4 (10.8) on the non-involved side, p = 0.001.

Significance

Transverse plane asymmetry in the femur was noted in mild unilateral cerebral palsy. Increased anatomical and dynamic internal rotation was compensated for by external pelvic rotation. Rotational malalignment may contribute to gait deviations in this mild group and should be part of the overall assessment.

中文翻译：

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痉挛性单侧脑瘫的解剖学和动态旋转对准。

背景

即使在轻度单侧脑瘫中，在身体和步态检查中也可以注意到髋关节内部旋转的增加。痉挛对横断面股骨生长的影响尚不清楚。运动模式中的这些偏差和不对称可能会对步态的效率产生负面影响，并引起对外观的心理担忧。

研究问题

在轻度单侧CP中受累侧的内部髋关节旋转是否常见，是否进行补偿性骨盆外部旋转以使脚的步伐对称？

方法

这项前瞻性研究包括45名单侧脑瘫患者，平均年龄17.7（13.0-24.0）岁。全部都是大运动功能分类I级。进行了身体检查，三维步态分析和磁共振成像以评估旋转对准。

结果

体格检查中，受累侧髋关节内部旋转平均为50.6（SD 10.4）度，非受累侧平均为44.3（SD 10.3），p = 0.001。

在计算整个步态周期的步态分析中，受累侧髋关节内部旋转平均为2.3（6.2）度，非受累侧髋关节内部旋转平均为1.8（7.6）度，p = 0.004。

患侧患侧骨盆旋转增加，平均2.0（4.3）度，非患侧对应骨内部旋转，平均3.6（4.4），p = 0.001。足部进展无差异，p = 0.067，外部平均分别为5.1（8.6）和3.9（6.4）。

磁共振成像显示受累侧股骨扭转平均为17.3（11.3）度，而非受累侧股骨扭转平均为11.4（10.8），p = 0.001。

意义

在轻度单侧脑瘫中发现股骨的横断面不对称。解剖和动态内部旋转的增加被骨盆外部旋转所补偿。旋转性错位可能导致该轻度人群的步态偏离，应作为整体评估的一部分。