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[微创全髋关节置换术后的步态分析]

[Gait analysis after minimally invasive total hip arthroplasty].

作者信息

Sander K, Layher F, Anders C, Roth A, Babisch J, Scholle H-C, Kinne R W

机构信息

Waldkrankenhaus Rudolf Elle GmbH, Lehrstuhl für Orthopädie des Universitätsklinikums Jena, Eisenberg, Deutschland.

出版信息

Orthopade. 2012 May;41(5):365-76. doi: 10.1007/s00132-011-1891-6.

Abstract

Upon implantation of a hip prosthesis by total hip arthroplasty (THA), clinical criteria are not always sufficient for an objective assessment of the functional outcome. Thus, functional improvement of gait behavior was comparatively validated by instrumented 3D gait analysis for a current, minimally invasive surgical approach (MIS; anterolateral approach) and a conventional, transgluteal approach (KONV). In selected cases, disturbed motion sequences were registered by measuring the muscle activity via high-resolution, monopolar surface electromyography (S-EMG) above the operation area. Despite continuous and significant improvement of practically all analyzed kinematic and kinetic gait parameters for both surgical approaches already after 5 weeks but in particular after 6 and 12 months, no significant differences were detected between the 2 procedures for any parameter or time point. The S-EMG demonstrated non-physiological muscle activation on the operated, but also on the non-operated side, even at 6 months after surgery. Advantages of the MIS approach thus seem primarily restricted to early, post-operative results, such as more rapid pain reduction and rehabilitation.

摘要

在通过全髋关节置换术(THA)植入髋关节假体时,临床标准并不总是足以对功能结果进行客观评估。因此,通过仪器化三维步态分析,对当前的微创外科手术方法(MIS;前外侧入路)和传统的经臀入路(KONV)进行比较,验证步态行为的功能改善情况。在选定的病例中,通过在手术区域上方进行高分辨率单极表面肌电图(S-EMG)测量肌肉活动,记录异常的运动序列。尽管两种手术方法在术后5周,尤其是6个月和12个月后,几乎所有分析的运动学和动力学步态参数都持续且显著改善,但在任何参数或时间点,两种手术方法之间均未检测到显著差异。S-EMG显示,即使在术后6个月,手术侧和非手术侧均存在非生理性肌肉激活。因此,MIS方法的优势似乎主要局限于早期术后结果,如更快的疼痛减轻和康复。

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