Gait deviations in patients operated on bladder extrophy

Abstract

Based on these vectors the forward – backward bending and rotation from the upper trunk with respect to lower trunk and pelvis, and from the lower trunk with respect to the pelvis were analyzed. Furthermore, the torsional offset (TO) [2] of upper trunkwith respect to lower trunkandpelvis andTOof lower trunkwith respect to pelvis were calculated in the different phases of the gait cycle. Results: In the scoliosis group, mean Cobb angle was 26.03◦ ±7.14 and mean spinal rotation was 22.77%±6.79. Sagital plane kinematics werewithin normal ranges at the ankle, knee and hip. High AI was found for frontal and transverse plane kinematics. In loading respons, AI for peak pelvis obliquity and peak hip exorotation in the scoliotic group was 13.39% and 49.83% respectively, compared to −16.58% and −7.6% in the control group. In pre-swing, AI for peak pelvis exorotation was −67.39% in the scoliotic group compared to 7.26% in the control group. In swing AI for peak hip abduction was −10.90% in the scoliotic group compared to -1.68% in the control group. Upper to lower trunk rotation was continuously clockwise in the scoliosis group while in the control group the rotation was symmetric. Upper trunk to pelvis motion showed a bending of 4.5◦ in the scoliosis group and 32.3◦ in the control group. Rotation was similar in both groups. Lower trunk to pelvis motion was similar in both groups with 3–4◦ of bending and 11.5–12◦ of rotation switching clockwise to anti-clockwise during the gait cycle, but the switch occurred later in the gait cycle in the scoliotic group. Discussion and conclusions: AI up to 14% are reported in normal subjects [2]. We found high AI for frontal and transverse plane motion compared to normal data,which canbe related to the spinal deformation in these planes. An excessive pelvic clockwise rotation coincides with an excessive anticlockwise torsion of the upper trunk. Compensatory hip rotation was found to align the legs into the walking direction. The lack of bending of the upper trunk and the delay in switch in rotation of the lower trunkwith respect to the pelvis might be due to the rotational deformity and rigidity of the scoliotic spine. Insight in how different parts of the trunk act during gait in subjects with scoliosis will enhance the understanding of the pathology and will provide information for optimized treatment. Therefore, further research on a larger population including kinetic analysis will be performed.