Swing gait

Introduction Duck steps or swing steps are common signs of congenital dislocation of the bone. Patients with unilateral dislocation have claudication, bilateral dislocations, pelvis leaning forward when standing, hips squatting, lumbar lordosis, abdomen bulging, and swinging when walking Duck steps or swing steps, walking a little faster, that is, easy to fall.

Cause

The cause of the swinging gait:

(A) Causes of the disease: There are many theories to explain the causes of congenital dislocation of the hip, such as mechanical factors, endocrine-induced joint relaxation, primary acetabular dysplasia and genetic factors. The breech position has abnormal mechanical stress on the hip, which can cause dislocation of the femoral head. Ligament relaxation has been considered as an important disease factor. The increase of estrogen secretion in the mother during the late pregnancy will relax the pelvis, which is conducive to childbirth. It also causes the fetus ligaments to relax in the uterus, and the femoral head dislocation is more likely to occur in the neonatal period. However, it is difficult to explain the cause of the disease with a single factor. It is generally believed that genetic and primary germplasm defects may play an important role in the pathogenesis. The hip joint of the fetus begins with a fissure formed by interstitial cartilage, which is firstly deep and concave, then gradually shallower and semi-circular. At birth, the humerus, ischium and pubis are only partially fused, and the acetabular fossa is extremely shallow, so the fetal hip joint has a large range of activity during childbirth, so that the fetus can easily pass through the birth canal. Therefore, the fetus is most prone to hip dislocation during the period before and after birth. If the lower extremity of the fetus is placed in the straight position, the femoral head is not easily placed in the depth of the acetabulum and is easily dislocated.

(B) the pathogenesis: the birth of the joint capsule relaxation as the main pathological changes, with age and dislocation, especially after the beginning of walking, the following pathological changes can gradually occur:

1. The joint capsule is elongated and adheres to the tibia. The middle part is dumbbell-shaped.

2. The acetabular lip is thickened and begins to be everted, and becomes inversion with increasing walking. The round ligament grows thicker and the transverse ligament is thicker. The acetabulum is poorly developed due to the lack of normal pressure stimulation of the femoral head, shallow and sloped.

3. Delayed development of femoral condyle and even avascular necrosis. The femoral neck anteversion angle and neck dry angle increased.

4. The femoral adductor muscle contracture, gluteal muscle relaxation.

5. False sputum is formed at the humeral wing. Pelvic tilt and compensatory scoliosis.

an examination

Related inspection

Duck step detection of bone and joint soft tissue CT examination general radiography

Check and diagnose the swing gait:

1, 1 symptom:

A. Joint movement disorder: The affected limb is often flexed, the activity is worse than the healthy side, and the pedaling force is on the other side. Hip abduction is limited.

B. Short-term injury of the affected limb: the affected femoral head is dislocated to the posterior superior position, and the corresponding lower limb shortening is common.

C. Changes in the skin and perineum: The skin folds on the buttocks and inner thighs are asymmetrical, and the affected side skin is deeper than the healthy side, and the number increases. The baby's labia majora is asymmetrical and the perineum is widened.

2 check:

A. Ortolani trial and Barlow trial: for congenital dislocation of the hip from birth to 3 months, first proposed by Ortolani in 1935, modified by Barlow. Ortolani's method is to bend the child's knees and hips to 90°. The examiner places the thumb on the inner side of the child's thigh, and the index and middle fingers are placed on the greater trochanter to gradually abduct and rotate the thigh. If dislocated, the femoral head can be felt embedded in the acetabular rim and produce a slight abduction resistance. Then, with the index finger and middle finger up, lift the greater trochanter, and the thumb can feel the bullet when the femoral head slides into the acetabulum, which is the Ortolani test positive. In contrast to the Ortolani test, the Barlow test allows the patient to passively adduct, rotate, and push the thumb outwards against the greater trochanter of the femur, again feeling a spring.

B.Allis sign (Galezzi sign): Make the newborn supine, bend the knee 85 ° ~ 90 °, the legs are close together, the two heels are aligned, if there is this disease, the height of the knees can be seen. This is caused by the upward movement of the affected femur.

C. Nesting test: the child is supine, the hip and knee joints of the affected side are flexed by 90°, the examiner holds the distal femur and the knee joint in one hand, and the other hand presses the groin of the affected limb. If the large rotor is moved up and down, it is positive for the nesting test.

D. Hip-knee flexion abduction test: the baby in the test is supine, the hip and knee joints are flexed, the examiner holds the knees with both hands, the thumb is on the inner side of the knee, and the other four fingers are on the outside of the knee. Normal infants can generally If the abduction is about 80°, if it is only 50° to 60°, it is positive, and only abduction 40° to 50° is strong positive.

2. Performance in early childhood:

1 symptom:

A. Minhang gait: Minhang is often the only complaint of parents when a child visits. When one side dislocated, it showed lameness; when dislocated, it showed "duck step". The child's buttocks were obviously protruding and the lumbar lordosis increased.

B. Short-term deformity of the affected limb: In addition to shortening, there is also an adduction deformity.

2 check:

A. Nelaton line: The anterior superior iliac spine and the ischial tuberosity are normally connected through the apex of the greater trochanter, called the Nelaton line, and the greater trochanter is above the line when the hip is dislocated.

B.Trende lenburg test: children stand on one leg, the other leg bends hips as far as possible, bends the knees, so that the feet are off the ground. When the hip is dislocated, the femoral head can not hold the acetabulum, the gluteus medius is weak, and the contralateral pelvis is lowered. It is especially clear from the back. It is called the Trende lenburg test positive and is unstable hip Signs.

Differential diagnosis

Symptoms of swaying gait :

1. Rooster gait: cock gait; when standing, the two thighs are close, the calves are slightly separated, the feet stand like toes, and when walking, the ballet is like a pointed walk.

2. gait: gait is a typical abnormal gait. When walking, the body swayed from side to side, showing a duck step. Common in neurological disorders, rickets, Kashin-Beck disease, progressive muscular dystrophy or bilateral congenital dislocation of the hip.

3. Dance-like gait: Dance-like gait is a clinical manifestation of chorea-like movements.

4. Walking is a big gait: walking is a big gait. The characteristic of deep sensory dysfunction is that the stride is larger when walking. The distance between the two legs is wider, and the foot height is higher. When the foot is strong, the eyes are gazing at the two eyes. Partial relief, unstable or even unable to walk when closed eyes, often accompanied by sensory disturbance Romberg sign positive in subacute combined degenerative spinal cord. It is one of the clinical manifestations of gait abnormalities.

Gait refers to the posture of the patient while walking. It is a complex exercise process that requires a high degree of coordination between the nervous system and the muscles, and involves many spinal reflexes and adjustments of the large and cerebellum, as well as the complete coordination of various posture reflexes, sensory systems, and motor systems. Therefore, observing gait often provides important clues to neurological diseases. Different diseases can have different special gaits, but gait is not the basis for diagnosis, but has a reference for diagnosis. Care should be taken to exclude gait abnormalities caused by bone deformities and bone, joint, muscle, blood vessels, skin and subcutaneous tissue.

5. Hemorrhoids gait: Gait abnormalities can be caused by movement or sensory disturbances, and their characteristics are related to the lesions. Hysteric gait: It can express grotesque gait. Although the muscle strength of the lower limbs is good, but it can not support the weight, it swings in all directions and seems to fall. When walking, the gait is dragged, but it is rare to fall. Seen in heart disease.

diagnosis:

1. Clinical manifestations: (1) performance in neonates and infancy:

1 Symptoms: A. Joint movement disorder: The affected limb is often flexed, the activity is worse than the healthy side, and the force on the other side is on the other side. Hip abduction is limited. B. Short-term injury of the affected limb: the affected femoral head is dislocated to the posterior superior position, and the corresponding lower limb shortening is common. C. Changes in the skin and perineum: The skin folds on the buttocks and inner thighs are asymmetrical, and the affected side skin is deeper than the healthy side, and the number increases. The baby's labia majora is asymmetrical and the perineum is widened.

2 examination: A. Ortolani test and Barlow test: for congenital dislocation of the hip from birth to 3 months, first proposed by Ortolani in 1935, improved by Barlow. Ortolani's method is to bend the child's knees and hips to 90°. The examiner places the thumb on the inner side of the child's thigh, and the index and middle fingers are placed on the greater trochanter to gradually abduct and rotate the thigh. If dislocated, the femoral head can be felt embedded in the acetabular rim and produce a slight abduction resistance. Then, with the index finger and middle finger up, lift the greater trochanter, and the thumb can feel the bullet when the femoral head slides into the acetabulum, which is the Ortolani test positive. In contrast to the Ortolani test, the Barlow test allows the patient to passively adduct, rotate, and push the thumb outwards against the greater trochanter of the femur, again feeling a spring. B.Allis sign (Galezzi sign): Make the newborn supine, bend the knee 85 ° ~ 90 °, the legs are close together, the two heels are aligned, if there is this disease, the height of the knees can be seen. This is caused by the upward movement of the affected femur. C. Nesting test: the child is supine, the hip and knee joints of the affected side are flexed by 90°, the examiner holds the distal femur and the knee joint in one hand, and the other hand presses the groin of the affected limb. If the large rotor is moved up and down, it is positive for the nesting test. D. Hip-knee flexion abduction test: the baby in the test is supine, the hip and knee joints are flexed, the examiner holds the knees with both hands, the thumb is on the inner side of the knee, and the other four fingers are on the outside of the knee. Normal infants can generally If the abduction is about 80°, if it is only 50° to 60°, it is positive, and only abduction 40° to 50° is strong positive.

(2) Early childhood performance:

1 Symptoms: A. Minhang gait: Minhang is often the only complaint of parents when a child visits. When one side dislocated, it showed lameness; when dislocated, it showed "duck step". The child's buttocks were obviously protruding and the lumbar lordosis increased. B. Short-term deformity of the affected limb: In addition to shortening, there is also an adduction deformity.

2 check: A.Nelaton line: The anterior superior iliac spine and the ischial tuberosity are normally connected through the apex of the greater trochanter, called the Nelaton line, and the greater trochanter is above the line when the hip is dislocated. B.Trende lenburg test: children stand on one leg, the other leg bends hips as far as possible, bends the knees, so that the feet are off the ground. When the hip is dislocated, the femoral head can not hold the acetabulum, the gluteus medius is weak, and the contralateral pelvis is lowered. It is especially clear from the back. It is called the Trende lenburg test positive and is unstable hip Signs.

2. Classification (1) According to the relationship between the femoral head and the acetabulum: generally can be divided into the following three types: 1 congenital dysplasia: the femoral head only moves slightly outward, the Shenton line is basically normal, but the CE angle can be Decreased, the acetabulum becomes shallower, and Dunn calls this a congenital dislocation of the hip. 2 congenital subluxation: the femoral head is displaced outwards, but still forms joints with the lateral part of the acetabulum, the Shenton line is discontinuous, the CE angle is less than 20°, and the acetabulum becomes shallow, belonging to the Dunn classification II. 3 congenital complete dislocation: the femoral head is completely outside the true acetabulum, forming a joint with the lateral aspect of the humerus, gradually forming a false acetabulum, the original joint capsule is embedded between the femoral head and the tibia, belonging to the Dunn classification III . (2) According to the degree of dislocation: Zionts standard, divided into the following 4 degrees: 1I degree dislocation: the femoral head nucleus is below the Y line, outside the upper edge of the acetabulum. 2 degree II dislocation: the femoral head nucleus lies between the parallel line of the upper edge of the y-line and the y-line. 3III degree dislocation: the femoral head nucleus is located at the height of the parallel line of the upper edge of the iliac crest. 4IV degree dislocation: the femoral head nucleus is located above the parallel line of the upper edge of the iliac crest and has false sputum formation.

Diagnosis can be established based on medical history, clinical manifestations, signs, X-ray examination and measurement.

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