Correlation of Functional and Radiological Results with Three-Dimensional Gait Analysis in Patients with Unilateral Slipped Capital Femoral Epiphysis

Yıl 2020, Cilt: 4 Sayı: 2, 161 - 168, 12.07.2020

Hanifi Üçpunar , Kubilay Beng Sebahat Aydil Timur Yıldırım , Mehmet Yağmurlu Avni İlhan Bayhan

https://doi.org/10.30565/medalanya.694570

Öz

Aim: The aim of this study was to evaluate the correlation between gait analysis and clinical and radiographic results in patients operated for slipped capital femoral epiphysis (SCFE).

Materials and Methods: This study included 31 patients with unilateral SCFE. The mean follow-up time was 3.3 ± 1.4 years. Harris hip score (HHS) and the Pediatric Outcomes Data Collection Instruments (PODCI) scores were collected. Slip-angle, alpha-angle, lateral femoral head ratio (LFHR), articulotrochanteric distance (ATD), anteroposterior plane femoral head ratio (AP-FHR), anterior head-neck offset ratio (HNOR), and neck-shaft angle (NSA) were measured. An age-matched control group consisting of 20 healthy individuals was used for comparison. 

Results: Transfer and basic mobility subscale of PODCI was correlated with pelvis tilt ROM (r = −0.7, p < 0.001), foot progression angle (FPA) ROM (r =−0.4, p=0.02), and mean spine tilt (r=−0.6, p<0.001). FPA was also correlated with the HHS (r=−0.5, p<0.001) and pain/comfort subscale of PODCI (r=−0.5, p=0.015). Significant correlations were detected between LFHR and mean hip flexion (r=−0.5, p<0.001), pelvic tilt (r=−0.4, p=0.04), and mean spine tilt (r=0.6, p<0.001). Correlations between ATD and mean internal rotation of the hip (r=0.5, p=0.03) and mean dorsal ankle extension (r=−0.4, p=0.03) were also significant. No significant correlation was found between the alpha angle, AP-FHR, and HNOR with the kinematic values.

Conclusion: Clinical scores of patients treated for SCFE were mostly correlated with pelvic tilt ROM, FPA, and spine tilt. LFHR and ATD were observed as the most critical radiological measurements related to a patient’s gait function.

Anahtar Kelimeler

Gait Analysis, Slipped Capital Femoral Epiphysis, Joint Kinematics, radiologic correlation, clinical correlation, impingement

Femur başı epifiz kayması tanılı hastalarda klinik ve radyolojik sonuçların yürüme analizi ile korelasyonu

Öz

Amaç: Bu çalışmanın amacı femur başı epifiz kayması (FBEK) nedeniyle opere edilen hastalarda yürüme analizi ile klinik ve radyolojik sonuçların korelasyonunu değerlendirmekti. 

Hastalar ve Yöntem: Bu çalışmaya ortalama takibi 3.3 ± 1.4 yıl olan tek taraflı FBEK tanısıyla opere edilen 31 hasta dahil edildi. Klinik değerlendirme Harris kalça skoru (HKS) ve Pediatrik Veri Toplama Aracı (PVTA) skoru ile yapıldı. Radyolojik değerlendirme için kayma açısı, alpha alçısı, lateral femur başı oranı, artikulotrokanterik mesafe (ATM), ön-arka planda femur başı oranı, anterior baş-boyun offset oranı ve boyun şaft açısı ölçümü yapıldı. Yaş eşleşmeli 20 sağlıklı bireyden kontrol grubu oluşturuldu. 

Bulgular: PVTA transfer ve temel mobilite alt ölçeği; pelvis tilt eklem hareket açıklığı (EHA) (r = −0.7, p <0.001), ayak ilerleme açısı EHA (r =−0.4, p=0.02) ve ortalama omurga tilti (r=−0.6, p<0.001) ile anlamlı korelasyon gösterdi. Ayrıca ayak ilerleme açısı ile HKS (r=−0.5, p<0.001) ve PVTA ağrı/konfor alt ölçeği anlamlı korelasyon gösterdi (r=−0.5, p=0.015). Lateral femur başı oranı ile ortalama kalça fleksiyonu (r=−0.5, p<0.001), pelvik tilti (r=−0.4, p=0.04) ve ortalama omurga tilti (r=0.6, p<0.001) koreleydi. ATM ile ortalama kalça iç rotasyonu (r=0.5, p=0.03) ve ortalama ayak bileği ekstansiyonu (r=−0.4, p=0.03) koreleydi. Alfa açısı, Ön-arka femur başı oranı ve anterior baş boyun ofsetinin kinematik değerlerle korelasyonu gösterilemedi. 

Sonuç: FBEK nedeniyle opere edilen hastalarda klinik skorlar çoğunlukla pelvik tilt EHA, ayak ilerleme açısı ve omurga tilti ile korelasyon gösterirken, radyolojik sonuçlardan lateral femur başı oranı ve ATM’nin yürüme fonksiyonu ile ilişkili olduğu anlaşılmıştır. 

Anahtar Kelimeler

yürüme analizi, femur başı epifiz kayması, eklem kinematiği, radyolojik korelasyon, klinik korelasyon

Kaynakça

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