Karam Matthew D, Gao Yubo, McKinley Todd
Hennepin County Medical Center, Minneapolis, MN, USA.
Iowa Orthop J. 2011;31:83-9.
Adult hip dysplasia (AHD) is a common etiology of hip pain in the young adult. Patients with adult hip dysplasia may present with hip pain and early degenerative changes resulting from elevated cumulative hip-contact stress. While there are numerous studies using radiographic parameters coupled with general and disease-specific health status measures to demonstrate that periacetabular osteotomy improves the orientation of the acetabulum, decreases pain and improves function, to our knowledge there is only one study that utilized gait analysis to demonstrate an objective functional alteration. The purpose of the present study was to prospectively evaluate the walking pattern and assess the activity level of patients undergoing periacetabular osteotomy for symptomatic adult hip dysplasia.
Institutional review board approval was obtained for collection and review of data on 55 patients who underwent periacetabular osteotomy at one institution by the senior author (TM) between the years 2007-2009. Walking pattern characteristics were assessed including velocity, cadence, stride length of the affected side, and percent of single-limb support on the affected limb using GaitRite® walking pattern analysis. Activity was assessed as average steps/day over a consecutive seven-day period. As a secondary analysis, the disease-specific and generalized health status outcome measures of all patients who underwent periacetabular osteotomy were reviewed.
At an average of 11.5 months post periacetabular osteotomy the walking patterns of 27 patients were available for review. Several trends were observed, including an approximate 5% increase in walking velocity (118 cm/sec to 125 cm/sec), and a 4.5 % increase in stride length (132 cm to 138 cm, p=0.01). At a mean 9.5 months following surgery, 26 patients reported an 8.75% decrease in average steps taken daily (4598 steps/day to 4196 steps/day). A significant improvement in SF-36 PC scores (p<0.01), the WOMAC hip pain and function scores (p<0.01) and the HHS (p<0.01) was noted during the same period.
At an average of 11.5 months following periacetabular osteotomy for the treatment of symptomatic hip dysplasia, a trend toward increased walking velocity and a significant increase in stride length was noted. A significant improvement in pain relief as well as improved physical function was observed in the short term. Subgroup analysis of patients without pre-existing osteoarthritis (as compared to those with pre-existing osteoarthrosis) revealed increased walking velocity, stride length of the affected limb, and percent of gait cycle in single support on the affected limb following periacetabular osteotomy. Further prospective studies are needed to fully clarify the long-term impact of the periacetabular osteotomy on patients with symptomatic hip dysplasia.
成人髋关节发育不良（AHD）是青壮年髋关节疼痛的常见病因。成人髋关节发育不良患者可能会出现髋关节疼痛以及由于累积的髋关节接触应力升高导致的早期退行性改变。虽然有大量研究使用影像学参数以及一般和疾病特异性健康状况指标来证明髋臼周围截骨术可改善髋臼方向、减轻疼痛并改善功能，但据我们所知，仅有一项研究利用步态分析来证明客观的功能改变。本研究的目的是前瞻性评估接受髋臼周围截骨术治疗有症状的成人髋关节发育不良患者的行走模式并评估其活动水平。
获得机构审查委员会批准，收集并审查2007年至2009年间由资深作者（TM）在一家机构为55例接受髋臼周围截骨术的患者所记录的数据。使用GaitRite®行走模式分析评估行走模式特征，包括速度、步频、患侧步长以及患侧单腿支撑百分比。活动量通过连续七天的日均步数进行评估。作为次要分析，对所有接受髋臼周围截骨术患者的疾病特异性和一般健康状况结局指标进行审查。
髋臼周围截骨术后平均11.5个月时，可对27例患者的行走模式进行审查。观察到了几个趋势，包括行走速度大约提高5%（从118厘米/秒提高到125厘米/秒），步长增加4.5%（从132厘米增加到138厘米，p = 0.01）。术后平均9.5个月时，26例患者报告日均步数减少了8.75%（从4598步/天减少到4196步/天）。同期还注意到SF - 36身体成分评分（p < 0.01）、WOMAC髋关节疼痛和功能评分（p < 0.01）以及髋关节 Harris 评分（HHS，p < 0.01）有显著改善。
在接受髋臼周围截骨术治疗有症状的髋关节发育不良平均11.5个月时，观察到行走速度有增加趋势且步长显著增加。短期内疼痛缓解和身体功能均有显著改善。对无既往骨关节炎患者（与有既往骨关节炎患者相比）的亚组分析显示，髋臼周围截骨术后患侧行走速度、患侧步长以及患侧单腿支撑步态周期百分比均增加。需要进一步的前瞻性研究来充分阐明髋臼周围截骨术对有症状的髋关节发育不良患者的长期影响。
