腿长不等的评估、临床意义和神经调控康复治疗

《绝地大师疼痛康复专题课程系列1.0》

第二十五讲腿长不等的评估、临床意义和神经调控康复治疗

Assessment and clinical significance of leg length discrepancy

1. Facts about leg length discrepancy (LLD)腿长不等(LLD)的事实

90% of population has some variance of LLD due to bony variance with 20% with a LLD of >9mm Chiropractic Osteopathy %的人群由于骨骼变异而有一定的腿长差异，20%的LLD为>9mm——脊骨神经整骨学，2005年

Two types of LLD: structural and functional 两种类型的LLD：结构性和功能性

Average LLD is about 11 mm 平均LLD约为11毫米

Shorter limbs carry an increased risk of knee osteoarthritis 较短侧腿会增加膝骨关节炎的风险

Longer limbs can carry a greater incidence of stress fractures 较长侧腿可能有较大的应力骨折发生率

2. Clinical key to remember 要记住的临床关键

LLD may not matter at all 腿长不等可能不重要

Most people adapt and even in significant LLD this may not be a problem 大多数人适应，甚至在明显腿长差异中，这可能也不是一个问题

However it is key to understand the possible cascade effects of LLD in along the kinetic chain and in the MSK system itself 然而，了解LLD在沿动力学链和肌骨系统本身中可能的级联效应是关键的

LLD is most commonly recognized during postural or gait assessment 在姿势或步态评估中，LLD最常被识别

3. Types of leg length discrepancy 腿长不等的类型

Structural: congenital, post-trauma, post-surgery 结构性：先天性、创伤后、手术后

Functional: due to joint or muscle contractures 功能性：由于关节或肌肉挛缩（疼痛跛行）

4. Structural LLD 结构性腿长不等

右侧腓骨缺失，左侧应力性骨折。

5. Structural leg length spinal effects 结构性腿长脊柱影响

左侧骨盆下降，鞋垫上推使骨盆水平。

6. Structural LLD causes DJD, fracture 结构性LLD导致退行性关节病变、骨折

7. LLD after hip replacement 髋关节置换术后腿长不等

Journal of Bone and Joint Surgery reported 18% of THA patients had an increase of leg length of 18% of more than 1.5cm.骨与关节外科杂志报道，18%的THA患者腿部长度增加，18%超过1.5cm。

LLD of up to 10mm is well tolerated by patients according to the clinical orthop related res.根据临床骨科学相关研究，患者LLD达到10mm可很好耐受。

Most LLD after surgery result from improper equipment selection before surgery.大多数LLD手术后LLD的原因是手术前植入物选择不当。

8. Functional LLD 功能性腿长不等

Causes of functional LLD 功能性LLD的原因：

Nerve injury foot drop 神经损伤-足下垂

Knee contracture following ligament injury going untreated.韧带损伤（ACL）未治疗后的膝关节挛缩。

Type 2 diabetes due to proprioceptive effects 2型糖尿病影响本体感觉

Chronic muscle tightness due to injury 因损伤引起的慢性肌肉紧张

Pain: antalgic adaptations ie. Limping 疼痛：避痛适应，即跛行

9. Consequences of pathomechanics 病理力学的结果

Maladaptions to LLD LLD的适应不良：

Muscle adaptation, inhibition, taut bands, trigger points etc 肌肉适应、抑制、紧绷带、激痛点等

Joint degeneration in the shorter limb 较短腿关节退变

Scoliotic curves 脊柱侧凸曲度

Risk of falling 跌倒风险

10. NORMAL GAIT 正常步态

EACH STEP IS A UNIQUE EVENT IN TIME 每一步都是一个独特的事件

FORCES ARE ABSORBED DIFFERENTLY EACH AND EVERYTIME 每次力量被吸收都不一样

THIS PRESERVES JOINTS AND SURROUNDING SOFT TISSUE 这样可以保护关节和周围软组织

NORMAL GAIT IS CHAOTIC 正常步态是混乱的。

11. COMPENSATORY GAIT 代偿步态LIMPING IS PREDICTABLE 跛行是可预测的。

EACH STEP FOLLOWS THE SAME PATTERN 每一步都遵循相同的模式。（足跟着地时中足锁定）

OVER TIME THE JOINTS AND SURROUNDING TISSUES ARE UNABLE TO ADAPT TO THE REPEATED FORCES AND THE TISSUE BEGINS TO CHANGE.随着时间，关节和周围组织无法适应重复力量，组织开始改变。

IE. CONTRACTION OF FASCIA, REDUCTION OF BLOOD FLOW, ADDITION OF NEUROGENIC INFLAMMATION ALL RESTRICT ACCESSORY MOVEMENTS 例如，筋膜收缩、血流减少，加上神经源性炎症-所有这些都限制附属运动。（运动链向上膝髋腰）

文章来源：《临床神经外科杂志》 网址: http://www.lcsjwkzzzz.cn/zonghexinwen/2021/0824/705.html