“生长痛”儿童下肢力线的测量及分布规律

Measurement and distribution of lower limb alignment in children with growing pains

目的观察“生长痛”儿童下肢力线的特点、分布规律，探寻“生长痛”的发生机制。方法对2006年6月至2012年6月收治的1789例门诊“生长痛”患儿进行下肢力线测量，并按年龄分为幼儿组（1～2岁，155例）、学龄前组（3～6岁，1249例）、学龄组（7～12岁，358例）和青少年组（≥13岁，27例），统计足行进角、股内旋角、股外旋角、下肢肢体力线、股足角、足底轴线和后距跟角指标，进行分布规律分析。结果“生长痛”患儿的平均就诊年龄为（5．7±2．1）岁，男女就诊人数比为18．5：1。幼儿组和学龄前组下肢力线主要表现为生理性膝外翻，分别占96．8％（150／155）和78．1％（975／1249）；学龄组下肢力线主要表现为足部旋转伴不对称，占64％（229／358）；青少年组为下肢扭转伴不对称，占100％（27／27）。“生长痛”患儿下肢扭转伴不对称主要表现为胫骨外扭转股骨内扭转，占69．5％（362／521），足部旋转伴不对称主要表现为双旋前足伴不对称，占54．7％（629／1150）。“生长痛”患儿肢体与足部力线均有改变的发生率为52．3％（936／1789），其中幼儿组发生率最高，为81．3％（126／155）。结论“生长痛”患儿就诊的高峰年龄为4～6岁，男多于女，且均存在下肢肢体和／或足部力线的改变，推测下肢扭转伴不对称和足部旋转伴不对称可能是导致“生长痛”的主要力线异常因素。

Objective To explore the characteristics and distribution of lower limb alignment in children with ＂growing pains＂ and explore the mechanism of ＂growing pains＂. Methods For 1,789 outpatients with ＂growing pains＂, measurements of lower limb alignment, including foot progression angle, femoral internal rotation angle, femoral external rotation angle, thigh-foot angle, limb alignment, plantar axis and posterior talocalcaneal angle, were made. They were divided into 4 groups of infants（1-2 yrs old, n = 155）, preschool children （3-6 yrs old, n = 1 249）, school-age children （7- 12 yrs old, n = 358）and youth （≥ 13 yrs old, n = 27）. Results The average age was （5.7 ± 2. 1） yrs old and the ratio of boys to girls was 18. 5 ： 1. The limb alignments in infant and preschool children groups were mostly for physiologic genu valgum, 96.8% （150/155） and 78. 1% （975/1249） respectively; in school-age group for asymmetric foot rotation （64%, 229/358） ; in youth group of lower limb asymmetric torsion （100%, 27/27）. The ＂growing pains＂ outpatients with lower limb asymmetric torsion were mostly of asymmetric tibial torsion mainly for bi-pronated asymmetric foot （54. 7%, 629/1150）. In ＂growing pains＂ patients, the change rate of lower limb and foot alignment was 52.3% （936/1789） and the highest incidence of infant group was 81.3M （126/155）. Conclusions All ＂growing pains＂ patients have alignment change with lower limbs and/or foot. Both lower limb asymmetric torsion and asymmetric foot rotation may be the most causative factors for ＂growing pains＂ in children.