Hulet C, Hurwitz D E, Andriacchi T P, Galante J O, Vielpeau C
Département d'Orthopédie, CHU de Caen, 14033 Caen Cedex.
Rev Chir Orthop Reparatrice Appar Mot. 2000 Oct;86(6):581-9.
This prospective study was conducted to analyze the mechanisms of gait compensation in patients with painful hip and to search for correlations with preoperative clinical and radiographic findings.
Optoelectronic and multicomponent force-plate datas were used to calculate joint motion, moments and intersegmental forces for 26 patients with unilateral hip pain and 20 normal age and sex-matched patients. Height was similar in the two groups but mean weight in the study group (83 kg) was greater than in the controls (68 kg). The preoperative Harris score was 53 in the study group and 16 patients had a permanent flexion contracture of the knee (mean 15 degrees, range 5-30 degrees). Radiographically, there were 22 cases of osteo-arthritis hip disease and 4 cases of necrosis.
Gait analysis showed a significant 0.66 +/- 0.06 m (12 p. 100) reduction in step length. Patients who had severe hip pain walked with a decreased dynamic range of motion (18 +/- 5 degrees, p<0.0001) with a curve reversal as they extended the hip. They also reduced dynamic range of motion of the knee and ankle. Patients who presented a reversal in their dynamic hip range of motion had a greater passive flexion contracture and a greater loss in range of motion during gait than those with a smooth regular pattern (p<0.0001). Patients with hip pain walked with significantly decreased external extension, adduction, and internal and external rotation moments (p<0.0001). They also unloaded the ipsilateral knee and ankle. The decreased hip extension moment was significantly correlated with an increased level of pain (p<0.0001). There was no correlation with radiological findings.
Reversal of dynamic hip range of motion was interpreted as a mechanism to increase effective hip extension during stance phase through increased anterior pelvic tilt and lumbar lordosis.
Patients with painful hip walked with a manner that was asymmetric. These gait modifications were related to hip limitation in passive motion and pain. Patients with flexion contracture adopted a compensatory gait mechanism. This study confirms relation between hip pain and forces across the hip joint.
本前瞻性研究旨在分析髋关节疼痛患者的步态代偿机制，并寻找与术前临床及影像学表现的相关性。
采用光电和多分量测力板数据，计算26例单侧髋关节疼痛患者及20例年龄和性别匹配的正常对照者的关节运动、力矩和节段间力。两组身高相似，但研究组平均体重（83千克）高于对照组（68千克）。研究组术前Harris评分为53分，16例患者存在膝关节永久性屈曲挛缩（平均15度，范围5 - 30度）。影像学检查显示，有22例髋关节骨关节炎疾病和4例坏死病例。
步态分析显示步长显著缩短0.66±0.06米（p < 0.0001）。髋关节疼痛严重的患者行走时动态运动范围减小（18±5度，p < 0.0001），髋关节伸展时出现曲线反转。他们还减小了膝关节和踝关节的动态运动范围。髋关节动态运动范围出现反转的患者比运动模式平稳规则的患者有更大的被动屈曲挛缩，且步态中运动范围损失更大（p < 0.0001）。髋关节疼痛患者行走时，外展、内收以及内外旋力矩显著降低（p < 0.0001）。他们还减轻了同侧膝关节和踝关节的负荷。髋关节伸展力矩降低与疼痛程度增加显著相关（p < 0.0001）。与影像学表现无相关性。
髋关节动态运动范围的反转被解释为一种机制，即通过增加骨盆前倾和腰椎前凸，在站立期增加有效髋关节伸展。
髋关节疼痛患者行走方式不对称。这些步态改变与髋关节被动运动受限和疼痛有关。屈曲挛缩患者采用了代偿性步态机制。本研究证实了髋关节疼痛与髋关节受力之间的关系。
