膝下O型腿与长短腿、脊柱侧弯（脊柱后凸）的关联性
初次就诊时，以“膝下O型腿+长短腿+腰椎前倾+胸椎后凸”为主。但最苦恼的是膝下O脚。
&以前对于长短腿和小驼背基本上没有认识。
&经过2个月的训练，长短腿得到明显矫正。&一年后的情况。双腿自然直立，对称匀称，步态流畅度提高。
&喜欢学习的朋友，可以看看以下的长短腿与脊柱变形的相关文章，很有道理。
The difference in the length of any limb, upper or lower, is
called limb-length discrepancy (LLD) or, depending on your author,
limb length inequality (LLI). Usually, upper limb LLD causes few
problems, unless the discrepancy is really significant and leads to
subsequent changes in arm function. I will, therefore, focus on LLD
in the legs. For ease of reference and, as it is often seen this
way, LLD will be used to mean leg-length discrepancy.
LLD is typically divided into two broad categories:
1. Structural discrepancies. These occur when
either the thigh (femur) or shin (tibia) bone or both bones in
one leg are different lengths to the corresponding bones in
the other leg. Small discrepancies between the length of bones on
each side of the problem occurs when the
difference in length is more pronounced (usually .5 to 1 inch
difference is considered within normal limits). A structural LLD
also is called a true leg length discrepancy and is considered a
true discrepancy because the cause is an actual physical length
difference in the lower extremity bones. Structural LLD is usually
as a result of genetic conditions, nutritional deficiency or
traumatic cause such as fracture or disease loss of bone. A fuller
guide is shown below:
a. Previous injury to bone. A broken bone can cause an LLD if
the bone heals in a shortened position. This typically occurs if
the bone fractures into several shards and is more likely in an
open fracture. Remarkably, broken bones in children can lead to
overgrowth of bone few years after healing, resulting in a longer
than normal bone. Overgrowth commonly occurs in young children with
femoral fractures. However, if the break runs through the growth
centre near the end of a bone and damages the cells responsible for
growth of the bone, this may cause slower growth, resulting in a
shorter leg.
b. Bone diseases. Bone disease such as osteomyelitis, can also
injure the growth plate, where growth in length occurs, so that a
discrepancy occurs gradually over time. Others include
neurofibromatosis, multiple hereditary exostoses and Ollier
disease. Bone tumours and the treatments designed to eradicate them
can also be related to leg length discrepancy. Tumours, like an
infection, can invade the growth plate and treatments, like
chemotherapy, can also damage the plate.
c. Bone infection. Bone can occur in children while they are
growing can cause significant LLD, especially if the infection
happens in infancy. Inflammation of joints during growth, such as
juvenile arthritis, can cause LLD.
d. Hemihypertrophy (one side too big) or hemiatrophy
(one side too small) are rare limb length discrepancy
conditions. In these conditions, the arm and leg on one side
of the body are either longer or shorter than the arm and leg on
the other side of the body. There may also be a difference between
the two sides of the face.
e. Other causes. Other causes include inflammation (arthritis)
and neurologic conditions.
f. Idiopathic difference. Sometimes the cause of limb length
discrepancy is unknown. These conditions are usually present at
birth, but the leg length difference may be too small to be
detected. As the child grows, the limb length discrepancy increases
and becomes more noticeable.
2. Functional discrepancies. These occur when
the leg lengths are equal but the symmetry is altered usually
somewhere above the hip which in turn disrupts the symmetry of the
legs. Functional LLD is more common than the structural form,
however the causes can be harder to determine. In functional LLD it
appears that one leg may be longer than the other, but there
is no significant difference in the length of the lower extremity
bones. Instead, a postural distortion above the hip joints has
caused one lower extremity to appear longer or shorter than
the other.
a. Sacroiliac joint dysfunctions leading to pelvic obliquity &
and I think the most common, at least in my clinic. This is
one of the key findings from a massive study carried out by
one of our co-authors, Augusto Manganiello was that just a
small LLD can lead to significant pelvic torsion and further sine
biomechanical problems.
b. Hip joint dysfunction causing compensatory alterations by the
joint and muscles that move the joint. Congenital (present at
birth) problems that alter alignment of the hips, such as coxa vara
and developmental dislocation of the hip fall into this
c. Neuromuscular problems, such as cerebral palsy, which causes
problems with alignment and posture can also lead to a functional
discrepancy.
d. I am told that a growth in muscle mass itself may lead to
LLD. Apparently, the Vastus lateralis muscle seems to push the
iliotibial band (ITB) laterally leading to femoral angle
compensations to maintain a line of progression during the gait
cycle. This is bound to be misdiagnosed as ITB syndrome and
subsequently treated incorrectly.
e. And the internal rotators of the lower limb being chronically
short or in a state of contracture though I hate this sort of
diagnosis as there’s never a decent answer to the why?
f. And apparently, failure or incorrect loading of the Back
Force Transmission System (the longitudinal-muscle-tendon-fascia
sling and the oblique dorsal muscle-fascia-tendon sling). See the
proceedings of the first and second Interdisciplinary World
Congress on Low Back Pain.
g. And one I found last week with a patient who has uber
lax ligaments and has developed one hyperflexed knee leading
to a subsequent low hip on that side.
It is important to distinguish between the two as they
are treated differently.
One study reported that 32% of 600 military recruits had a
1/5 inch to a 3/5 inch difference between the lengths of their
legs. In a study by a bloke called Knutson, who is no slouch, he
concluded:
“Using data on leg-length inequality obtained by accurate
and reliable x-ray methods, the prevalence of anatomic inequality
was found to be 90%, the mean magnitude of anatomic inequality was
5.2 mm (SD 4.1). The evidence suggests that, for most people,
anatomic leg-length inequality does not appear to be clinically
significant until the magnitude reaches ~ 20 mm (~3/4&P).
Conclusion
Anatomic leg-length inequality is near universal, but the average
magnitude is small and not likely to be clinically
significant.”
The most accurate way to identify a structural LLD is with a
lower extremity radiograph that allows a comparison of bone
measurement with the other limb. If this is not an option, a
comparison of the measurement between bony landmarks on each side
with a tape measure is another option, although it is somewhat less
Structural discrepancies
For structural LLD the therapeutic goal must be to flatten the
pelvis. Treatment of structural LLDs depends on the severity of
discrepancy and the requirements of the patient. Treatment is done
in the following ways:
1. Orthotics: A shoe lift can be used to treat discrepancies up
to 2 cm. The lift should be large enough to allow the patient to
walk normally.
2. Shortening procedures: The following procedures, used to
shorten the longer leg, may be recommended for some children, in
cases where the leg length discrepancy is expected to be between 2
and 6 cm at maturity. Shortening is considered safer and results in
less complications than lengthening procedures:
a. Epiphysiodesis & This procedure slows the rate of growth of
the long leg, allowing the short leg to catch up. The operation
involves the creation of bony ridge, usually by repositioning a
block of bone in the region, that tethers the growth plate,
preventing future growth. The disadvantages of this procedure
include shortened stature, surgery on the unaffected extremity, and
the irreversibility of the procedure.
b. Epiphyseal stapling & This operation is performed to slow the
rate of the growth temporarily. Staples are surgically inserted on
each side of the growth plate. Once equalization has been
achieved, the staples are removed.
c. Bone resection & This operation, removal of a section of bone
to equal out the discrepancy, can be performed in adults or
adolescents who are no longer growing.
3. Lengthening procedures are usually reserved for discrepancies
that are more than 4 cm. While one of the obvious advantages
of lengthening is the achievement of height, it is not always the
method of choice because the process used is technically difficult
and has a significant rate of complications, discussed further
For this procedure, a customized apparatus that encircles the
leg is surgically attached to the limb that will be lengthened by
pins. Limb lengthening correction works on the principle of bone
regeneration (osteogenesis) as segments of the bone are pulled
apart (distracted). To achieve this, a bone is first cut in two
during surgery. Days after surgery, the two ends of the bone are
very gradually pulled apart through continual adjustments that are
made to the apparatus, usually at a rate of 1 mm per day. This
gradual distraction leads to formation of new bone between the two
ends, at the site of lengthening. After the process is complete,
and the bone is given a chance to harden, the apparatus is
surgically removed. A cast or brace may be required for some time
for further protection. Common complications associated with
lengthening procedures include pin tract infection, wound
infection, hypertension, partial dislocation of the hip and knee, a
delayed union of the bone and fatigue fractures after removal of
the lengthening apparatus.
4. Prosthetics: These devices, which are typically used to treat
a child who has had to have an amputation, may be satisfactory for
some patients with very large discrepancies, who would not benefit
from other lengthening or shortening procedures
But, any structural LLD &20 mm and LLD caused by
supra-pelvic muscle hypertonicity may interact in a standing
posture, but not in an prone or supine posture as they are unloaded
postures. So, any LLD due to suprapelvic muscular hypertonicity
should be eliminated before any necessary treatment of structural
LLD starts.
The lateral flexion of the lumbar spine was assessed in a group
of subjects 10 years after structural LLD caused by femoral
fracture that occurred after they were skeletally mature. Despite
the compensatory lumbar scoliosis, these subjects had symmetrical
lumbar lateral flexion, prompting the authors to comment that the
“…acquired leg-length discrepancy produced little permanent
structural abnormality in the lumbar spine…”. So, significant
anatomic LLD acquired after skeletal maturity does not result in
adaptive structural changes within a 10-year period.
However, another study from the same orthopaedic centre looked
at the effects of significant (so about 3 cm) structural LLD
acquired prior to skeletal maturity in mature subjects (so between
17&38 years old). In this group, there was considerable asymmetry
of lumbar lateral flexion after placing a lift under the short leg
to level the pelvis. This indicates that the body had permanently
compensated to the structural changes in the spine/pelvis.
This type of permanent compensation in preskeletal maturity LLD
was also found in subjects with pelvic obliquity. Young et al.
found that placing a lift under the foot of a subject with no
pelvic obliquity resulted in greater lumbar lateral flexion towards
the now high iliac crest side. In subjects with pelvic obliquity,
when the lift was put under the foot on the side of the low iliac
crest in order to level the crest, lateral flexion was increased
towards the formerly low crest side. If the body remodels and
adapts to the pelvic obliquity or torsion caused by anatomic LLI,
then by putting a lift under the side of the “low” iliac crest,
one is actually raising what the body has adapted to as
level. In other words, the unlevel pelvis of those with anatomic
LLI has been adapted to and is now “normal”, and putting a lift
under the low side has the same effect as putting a lift under the
leg of an even pelvis!
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