原创 O形腿的治疗
2018年09月07日 【健康号】 许树柴     阅读 8514

膝关节病

Bowed Legs(弓状腿)

Bowed legs in a toddler is very common.When a child with bowed legs stands with his or her feet together,there is a distinct space between the lower legs and knees.This may be a result of either one,or both,of the legs curving outward.Walking often exaggerates this bowed appearance.Adolescents occasionally have bowed legs.In many of these cases,the child is significantly overweight.

弓状腿在蹒跚学步的儿童中很常见。当弓状腿的儿童双脚并拢站立时,两小腿和两膝关节之间会有明显的距离,这可能是由于一条腿或者两条腿向外旋转造成的。走路时会使这种弯曲畸形更加明显。青少年偶尔会有弧形腿,这种情况的孩子通常是明显超重的。

Cause(病因)

Physiologic Genu Varum(生理性膝内翻)

In most children under 2 years old,bowing of the legs is simply a normal variation in leg appearance.Doctors refer to this type of bowing as physiologic genu varum.

大多数2岁以下的儿童孩子,双腿弓状弯曲仅仅是腿部外观的正常变化。医生把这种类型的弯曲定义为生理性膝内翻。

In children with physiologic genu varum,the bowing begins to slowly improve at approximately 18 months of age and continues as the child grows.By ages 3 to 4,the bowing has corrected and the legs typically have a normal appearance.

生理性膝内翻的儿童,腿的弯曲在大约18个月龄开始慢慢好转,随着年龄的增长逐渐改善。到3-4岁时,腿的弯曲已能纠正,也具有了正常的外观。

Blount's Disease(布朗特氏病)

左图:Toddler with infantile Blount's disease involving the left leg.右图X-ray of the left knee shows the Blount's abnormality along the top of the shinbone.

患有婴儿型布朗特氏病的幼儿被累及左腿。左膝X线显示胫骨近端的异常。

Blount's disease is a condition that can occur in toddlers,as well as in adolescents.It results from an abnormality of the growth plate in the upper part of the shinbone(tibia).Growth plates are located at the ends of a child's long bones.They help determine the length and shape of the adult bone.

布朗特氏病可发病于婴幼儿和青少年。这种疾病将导致胫骨近端的骨骺发育异常。骨骺位于儿童长骨的两端,它们有助于决定成年骨的长度和形状。

In a child under the age of 2 years,it may be impossible to distinguish infantile Blount's disease from physiologic genu varum.By the age of 3 years,however,the bowing will worsen and an obvious problem can often be seen in an x-ray.

2岁以下的幼儿,可能无法区分究竟是婴儿型布朗特氏病还是生理性膝内翻。然而,到3岁时,患有布朗特氏病的儿童腿的弯曲更加严重,X线片也通常能发现明显的问题。

Rickets(佝偻病)

Rickets is a bone disease in children that causes bowed legs and other bone deformities.Children with rickets do not get enough calcium,phosphorus,or Vitamin D—all of which are important for healthy growing bones.

佝偻病是一种儿童骨病,会导致弓状腿和其他骨骼畸形。患有佝偻病的儿童通常缺钙、磷或者维生素D,而这些都是骨骼健康生长的重要元素。

Nutritional rickets is unusual in developed countries because many foods,including milk products,are fortified with Vitamin D.Rickets can also be caused by a genetic abnormality that does not allow Vitamin D to be absorbed correctly.This form of rickets may be inherited.

营养性佝偻病在发达国家很少见,因为许多食品(包括乳制品)都富含维生素D。佝偻病还可以因基因异常导致不能吸收维生素D造成,这种类型的佝偻病可能是遗传的。

Symptoms(症状)

Bowed legs are most evident when a child stands and walks.The most common symptom of bowed legs is an awkward walking pattern.

弓状腿在儿童站立和行走时最明显。最常见的症状就是一种“笨拙”的走路方式。

Toddlers with bowed legs usually have normal coordination,and are not delayed in learning how to walk.The amount of bowing can be significant,however,and can be quite alarming to parents and family members.

患有弓状腿的幼儿通常有正常的协调性,也不会因此推迟学步。然而,腿的弯曲量会变得很明显,足以惊醒父母和家庭成员。

Turning in of the feet(intoeing)is also common in toddlers and frequently occurs in combination with bowed legs.

患有弓状腿的幼儿通常也会发生拇内翻。

Bowed legs do not typically cause any pain.During adolescence,however,persistent bowing can lead to discomfort in the hips,knees,and/or ankles because of the abnormal stress that the curved legs have on these joints.In addition,parents are often concerned that the child trips too frequently,particularly if intoeing is also present.

弓状腿通常不会造成任何疼痛。然而到了青春期,随着腿长期弯曲形成的异常异常应力会导致髋关节、膝关节或者踝关节的不适。此外,父母通常会误以为孩子的不适是由于旅行过于频繁引起,尤其是如果孩子有拇内翻的话。

Tests

Your doctor will begin your child's evaluation with a thorough physical examination.

医生会对您的孩子做全面的体格检查从而进行评估。

If your child is under age 2,in good health,and has symmetrical bowing(the same amount of bowing in both legs),then your doctor will most likely tell you that no further tests are currently needed.

如果您的孩子是2岁以下,身体健康并且双腿具有对称的弓状弯曲(双腿弯曲量相同),那么您的医生很可能会告诉您目前不需要进一步测试。

However,if your doctor notes that one leg is more severely bowed than the other,he or she may recommend an x-ray of the lower legs.An x-ray of your child's legs in the standing position can show Blount's disease or rickets.

但是,如果您的医生认为您孩子的一条腿比另一条腿弯曲得更严重,他会建议对小腿进行X线检查。小腿站立位X线能显示布朗特氏病或佝偻病

If your child is older than 2 1/2 at the first doctor's visit and has symmetrical bowing,your doctor will most likely recommend an x-ray.The likelihood of your child having infantile Blount's disease or rickets is greater at this age.If the x-ray shows signs of rickets,your doctor will order blood tests to confirm the presence of this disorder.

如果您的孩子初次就诊时大于两岁半并且双腿对称弯曲,您的医生也将建议进行X线检查,因为在这个年龄段小孩患布朗特氏病或佝偻病的可能性更大。如果X线显示佝偻病的征象,会进行验血以确诊。

Treatment(治疗)

Natural Progession of Disease(疾病自然进展)

Physiologic genu varum nearly always spontaneously corrects itself as the child grows.This correction usually occurs by the age of 3 to 4 years.

生理性膝内翻会随着儿童年龄的增长自然纠正。纠正过程通常发生在3-4岁时。

An adolescent with Blount's disease.(一名患有布朗特氏病的少年)

Untreated infantile Blount's disease or untreated rickets results in progressive worsening of the bowing in later childhood and adolescence.Ultimately,these children have leg discomfort(especially the knees)due to the abnormal stresses that occur on the joints.Adolescents with Blount's disease are most likely to experience pain with the bowing.

未经治疗的婴儿型布朗特氏病或佝偻病将导致孩子的腿在童年后期和青春期弯曲得更加严重。最终,这些孩子由于关节的异常应力会造成腿部的不适(尤其是膝关节)。患有布朗特氏病的青少年最有可能经历腿的弯曲带来的痛苦。

Nonsurgical Treatment(保守治疗)

Physiologic genu varum.Although physiologic genu varum does not require active treatment,your doctor will want to see your child every 6 months until the bowing has resolved.

生理性膝内翻:虽然生理性膝内翻不需要积极治疗,但您的医生仍希望每6个月见一次您的孩子,直到腿的弯曲已经消失。

Blount's disease.Infantile Blount's disease does require treatment for the bowing to improve.If the disease is caught early,treatment with a brace may be all that is needed.Bracing is not effective,however,for adolescents with Blount's disease.

布朗特氏病:婴儿型布朗特氏病需要治疗来改善腿部的弯曲。如果早期发现这种疾病,可能仅需要支具治疗就足够了。但对于患有布朗特氏病的青少年,支具治疗是无效的。

Rickets.If your child has rickets,your doctor will refer you to a metabolic specialist for medical management,in addition to regular orthopaedicfollowup.The effects of rickets can often be controlled with medication.

佝偻病:如果您的孩子患有佝偻病,除了常规的骨科随访,医生还会为您推荐代谢专家为您的孩子进行诊疗。佝偻病的影响通常是可以通过药物控制的。

Surgical Treatment(手术治疗)

Physiologic genu varum.In rare instances,physiologic genu varum in the toddler will not completely resolve and during adolescence,the bowing may cause the child and family to have cosmetic concerns.If the deformity is severe enough,then surgery to correct the remaining bowing may be needed.

生理性膝内翻:在极少数的情况下,幼儿的生理性膝内翻直到青春期也没有彻底纠正,弓状腿会使孩子和家人关注美观问题。如果畸形足够严重,那么就需要手术纠正多余的弯曲。

Blount's disease.If bowing continues to progress in a child with infantile Blount's disease despite the use of a brace,surgery will be needed by the age of 4 years.Surgery may stop further worsening and prevent permanent damage to the growth area of the shinbone.

布朗特氏病:如果使用了支具纠正仍不能阻止婴儿型布朗特氏病的继续进展,那么到了4岁时就可以采取手术治疗。手术会阻止病情的进一步恶化并防止胫骨生长区受到持续的损害。

Older children with bowed legs due to adolescent Blount's disease require surgery to correct the problem.

因患青少年型布朗特氏病造成弓状腿的孩子也需要手术来解决问题。

Rickets.Surgery may also be needed for children with rickets whose deformities persist despite proper management with medications.

佝偻病:用药物治疗但畸形仍存在的佝偻病患儿同样需要手术治疗。


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许树柴
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