全髋关节置换术和髋关节表面置换术中的步态与楼梯功能:一项初步研究。

Gait and stair function in total and resurfacing hip arthroplasty: a pilot study.

作者信息

Shrader M Wade, Bhowmik-Stoker Manoshi, Jacofsky Marc C, Jacofsky David J

机构信息

Sun Health Research Institute and Center for Orthopedic Research and Education, Sun City West, AZ 85375, USA.

出版信息

Clin Orthop Relat Res. 2009 Jun;467(6):1476-84. doi: 10.1007/s11999-009-0791-0. Epub 2009 Mar 21.

Abstract

Standard total hip arthroplasty (THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis but survivorship curves wane in patients younger than 50. Resurfacing hip arthroplasty (RHA) is an alternative for younger, active patients reportedly providing superior range of motion. Quantitative investigation of functional recovery following arthroplasty may elucidate limitations that aid in device selection. Although limited long-term kinematic data are available, the early rate of recovery and gait compensations are not well described. This information may aid in refining rehabilitation protocols based on limitations specific to the implant. We presumed hip motion and forces for subjects receiving RHA are more similar to age-matched controls during physically demanding tasks, such as stair negotiation, at early time points than those for THA. In a pilot study, we quantified walking and stair negotiation preoperatively and 3 months postoperatively for seven patients with RHA (mean age, 49 years), seven patients with standard THA (mean age, 52 years), and seven age-matched control subjects (mean age, 56 years). Although both treatment groups demonstrated trends toward functional recovery, the RHA group had greater improvements in hip extension and abduction moment indicating typical loading of the hip. Further investigation is needed to determine if differences persist long term or are clinically meaningful.

摘要

标准全髋关节置换术(THA)是针对65岁以上患有进行性骨关节炎患者的既定手术治疗方法,但50岁以下患者的生存率曲线会下降。髋关节表面置换术(RHA)是年轻、活跃患者的一种替代选择,据报道它能提供更好的活动范围。对关节置换术后功能恢复的定量研究可能会阐明有助于器械选择的局限性。尽管长期运动学数据有限,但早期恢复率和步态代偿情况并未得到很好的描述。这些信息可能有助于根据植入物特有的局限性来完善康复方案。我们推测,在诸如上下楼梯等体力要求较高的任务中,接受RHA的受试者在早期髋关节运动和受力情况比接受THA的受试者更类似于年龄匹配的对照组。在一项初步研究中,我们对7例RHA患者(平均年龄49岁)、7例标准THA患者(平均年龄52岁)和7例年龄匹配的对照受试者(平均年龄56岁)在术前和术后3个月的行走及上下楼梯情况进行了量化。尽管两个治疗组均显示出功能恢复的趋势,但RHA组在髋关节伸展和外展力矩方面有更大改善,表明髋关节的典型负荷情况。需要进一步研究以确定这些差异是否长期存在或具有临床意义。

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