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儿童足内旋介绍

Author
Scott B Rosenfeld, MD
Section Editor
William Phillips, MD
Deputy Editor
Mary M Torchia, MD
Translators
徐晨阳, 主治医师

引言

足内旋(“内八字脚”)是指行走时足或趾朝向中线的一种下肢旋转性变异(图 1)。足外旋是指行走时足或趾尖背离中线的一种下肢旋转性变异(图 1)。

足内旋和足外旋是儿科初级保健医生所遇到的最常见的肌肉骨骼解剖变异中的两种，也是将患儿转诊至小儿骨科医生处的常见原因。然而，大多数足内旋或足外旋的儿童存在正常的下肢发育变异，这些变异型可自行改善，并且可由初级保健医生进行监测。

了解下肢的正常生长发育对评估儿童旋转对齐非常重要，并有助于阐明足内旋的机制。儿童足内旋最常见的原因有：跖内收、胫骨内旋以及股骨前倾增大。这些旋转异常可见于正常的健康儿童，极少会持续到青春期。即使持续存在，足内旋也极少引起功能障碍[1]。通过病史及体格检查一般就足以鉴别常见的旋转性变异与少见的病理性足内旋和足外旋原因(如，偏瘫性脑性瘫痪)。 (参见下文‘评估’)

本专题将总结下肢旋转发育、足内旋的常见原因、必须排除的足内旋病理性原因以及评估和处理儿童足内旋的方法。足外旋将单独讨论。 (参见“儿童足外旋介绍”)

正常的生理力线对齐

下肢旋转对齐是由足的力线对齐、胫骨相对于股骨内外髁轴线的旋转(胫骨扭转)以及股骨颈相对于股骨内外髁轴线的旋转(股骨前倾)所决定的(图 2)。足内旋和足外旋可能在6月龄到5岁之间加重，这正是儿童走路和协调能力的发展时期[2]。正常生长和改善的协调能力通常使得旋转变异自行恢复(表 1)。

                     

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Literature review current through: 2017-06 . | This topic last updated: 2017-02-15.
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