Foucher Kharma C, Hurwitz Debra E, Wimmer Markus A
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Biomech. 2007;40(15):3432-7. doi: 10.1016/j.jbiomech.2007.05.020. Epub 2007 Jul 17.
The purpose of this study was to evaluate whether preoperative gait adaptations persist one year after THR in the same set of subjects. The hypothesis tested was that hip dynamic range of motion and peak external moments during walking return to normal after THR. Hip kinematics and kinetics were measured for 28 subjects before and one year after THR and compared to those of 25 subjects with radiographically normal hips. All THR subjects improved clinically after surgery with Harris hip scores improving from 33-85 (average 53) to 61-100 (average 95) (sign test p<0.001). Preoperatively dynamic hip range of motion (ROM), and all peak external moments were reduced compared to normal (Mann-Whitney p< or =0.040). Improvement was seen in the ROM and all but the frontal plane, and external rotation peak moments (Friedman p< or =0.023). The preoperative and postoperative values of the ROM, and peak flexion, abduction and external rotation moments were all significantly correlated (Spearman p<0.020) indicating a possible learned effect from before THR surgery. Postoperative THR subjects continued to have a significantly lower than normal ROM, and peak adduction and peak internal rotation moments (Mann-Whitney p< or =0.003). Despite good to excellent clinical functional outcome, gait in THR patients does not return to normal by one year after surgery. Aggressive muscle strengthening is currently not emphasized after THR surgery. Some THR patients may benefit from more intensive rehabilitation before and after surgery.
本研究的目的是评估在同一组受试者中，全髋关节置换术（THR）后一年术前步态适应性是否持续存在。所检验的假设是，THR后行走时髋关节动态活动范围和峰值外力矩恢复正常。在28名受试者THR术前和术后一年测量其髋关节运动学和动力学，并与25名髋关节X线检查正常的受试者进行比较。所有THR受试者术后临床症状均有改善，Harris髋关节评分从33 - 85（平均53）提高到61 - 100（平均95）（符号检验p<0.001）。与正常情况相比，术前髋关节动态活动范围（ROM）和所有峰值外力矩均降低（Mann - Whitney检验p≤0.040）。ROM以及除额平面和外旋峰值力矩外的所有指标均有改善（Friedman检验p≤0.023）。ROM以及峰值屈曲、外展和外旋力矩的术前和术后值均显著相关（Spearman检验p<0.020），表明THR手术前可能存在学习效应。THR术后受试者的ROM以及峰值内收和峰值内旋力矩仍显著低于正常水平（Mann - Whitney检验p≤0.003）。尽管临床功能结局良好至优秀，但THR患者术后一年步态仍未恢复正常。目前THR手术后未强调积极的肌肉强化训练。一些THR患者可能在手术前后从更强化的康复训练中获益。
