Lin XiaoBin, Meijer Onno G, Lin JianHua, Wu WenHua, Lin XiaoCong, Liang BoWei, van Dieën Jaap H, Bruijn Sjoerd M
First Clinical College of Fujian Medical University, Fuzhou, Fujian, PR China; Department of Orthopaedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, PR China; Department of Orthopaedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China; Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China.
Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands.
Clin Biomech (Bristol). 2015 Oct;30(8):874-80. doi: 10.1016/j.clinbiomech.2015.05.014. Epub 2015 May 29.
Hip abductor weakness and unilateral pain in patients with moderate hip osteoarthritis may induce changes in frontal plane kinematics during walking that could affect stability and fall risk.
In 12 fall-prone patients with moderate hip osteoarthritis, 12 healthy peers, and 12 young controls, we assessed the number of falls in the preceding year, hip abductor strength, fear of falling, Harris Hip Score, and pain. Subjects walked on a treadmill with increasing speeds, and kinematics were measured opto-electronically. Parameters reflecting gait stability and regressions of frontal plane center of mass movements on foot placement were calculated. We analyzed the effects of, and interactions with group, and regression of all variables on number of falls.
Patients walked with quicker and wider steps, stood shorter on their affected leg, and had larger peak speeds of frontal plane movements of the center of mass, especially toward their unaffected side. Patients' static margins of stability were larger, but the unaffected dynamic margin of stability was similar between groups. Frontal plane position and acceleration of the center of mass predicted subsequent step width. The peak speed of frontal plane movements toward unaffected had 55% common variance with number of falls, and adding the Harris Hip Score into bivariate regression led to 83% "explained" variance.
Quickening and widening steps probably increase stability. Shorter affected side stance time to avoid pain, and/or weakened affected side hip abductors, may lead to faster frontal plane trunk movements toward the unaffected side, which could contribute to fall risk.
中度髋骨关节炎患者的髋外展肌无力和单侧疼痛可能会在行走过程中引起额面运动学变化，进而影响稳定性和跌倒风险。
我们评估了12名有跌倒倾向的中度髋骨关节炎患者、12名健康同龄人以及12名年轻对照者上一年的跌倒次数、髋外展肌力量、跌倒恐惧、Harris髋关节评分和疼痛情况。受试者在跑步机上以逐渐增加的速度行走，采用光电测量运动学数据。计算反映步态稳定性的参数以及质心在额面运动对足部位置的回归。我们分析了分组的影响及相互作用，以及所有变量对跌倒次数的回归。
患者行走时步幅更快、更宽，患侧腿站立时间更短，质心在额面运动的峰值速度更大，尤其是向健侧方向。患者的静态稳定裕度更大，但各组之间健侧的动态稳定裕度相似。质心在额面的位置和加速度可预测后续步幅宽度。向健侧额面运动的峰值速度与跌倒次数有55%的共同方差，将Harris髋关节评分纳入双变量回归后，可解释83%的方差。
加快步幅和加宽步幅可能会增加稳定性。为避免疼痛而缩短患侧站立时间，和/或患侧髋外展肌无力，可能会导致躯干在额面更快地向健侧移动，这可能会增加跌倒风险。
