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手术入路对全髋关节置换术后步态力学的影响。

The effect of surgical approach on gait mechanics after total hip arthroplasty.

作者信息

Zeni Joseph, Madara Kathleen, Witmer Hunter, Gerhardt Riley, Rubano James

机构信息

Rutgers, The State University of New Jersey, Department of Health and Rehabilitation Sciences, School of Health Professions, Physical Therapy Program - North, Newark, NJ 07107, United States; University of Delaware, Biomechanics and Movement Science Program, Newark, DE 19713, United States.

Rutgers, The State University of New Jersey, Department of Physical Therapy, Newark, NJ 07107, United States; University of Delaware, Department of Physical Therapy, Newark, DE 19713, United States.

出版信息

J Electromyogr Kinesiol. 2018 Feb;38:28-33. doi: 10.1016/j.jelekin.2017.11.004. Epub 2017 Nov 10.

Abstract

BACKGROUND

Few studies have compared the biomechanical outcomes of different surgical approaches for hip arthroplasty. The purpose of this study was to compare hip, pelvic, and trunk kinematics and kinetics between individuals who underwent a posterior or anterolateral approach.

METHODS

Forty-five individuals between 40 and 80 years old underwent motion analysis during overground gait prior to hip arthroplasty and 3 months after surgery. Walking speed, hip flexion angle, hip extension angle, adduction angle and moment, trunk angle, trunk lean, and pelvis drop were compared between approaches.

FINDINGS

There were 30 subjects in the posterior group and 15 subjects in the anterolateral group. The groups did not change differently over time as there were no significant interaction effects. However, there were main effects for time; walking speed increased 19.9% (p < .001), hip flexion angle increased 3.3 degrees (p = 0.014) and peak hip extension increased 4.5 degrees (p = .001), and peak hip adduction significantly increased 1.9 degrees (p = .004) for the sample as a whole. Trunk angle (p = .283) and trunk lean (p = .401) did not significantly change between time points, but there was a significant increase in pelvic drop (p = .003).

INTERPRETATION

Surgical approach did not affect biomechanical outcomes 3 months after arthroplasty. Both groups showed improvement in sagittal plane hip kinetics and kinematics. However, increased pelvic drop may be indicative of residual hip weakness in both groups.

摘要

背景

很少有研究比较不同手术入路进行髋关节置换术后的生物力学结果。本研究的目的是比较采用后外侧或前外侧入路的患者之间的髋关节、骨盆和躯干的运动学及动力学情况。

方法

45名年龄在40至80岁之间的患者在髋关节置换术前及术后3个月进行了地面行走时的运动分析。比较了两种入路之间的步行速度、髋关节屈曲角度、髋关节伸展角度、内收角度及力矩、躯干角度、躯干倾斜度和骨盆下降情况。

结果

后外侧组有30名受试者,前外侧组有15名受试者。由于没有显著的交互作用,两组随时间的变化没有差异。然而,存在时间的主效应;总体样本的步行速度提高了19.9%(p<0.001),髋关节屈曲角度增加了3.3度(p=0.014),髋关节伸展峰值增加了4.5度(p=0.001),髋关节内收峰值显著增加了1.9度(p=0.004)。躯干角度(p=0.283)和躯干倾斜度(p=0.401)在各时间点之间没有显著变化,但骨盆下降有显著增加(p=0.003)。

解读

手术入路在关节置换术后3个月不影响生物力学结果。两组在矢状面髋关节动力学和运动学方面均有改善。然而,骨盆下降增加可能表明两组均存在残余髋关节无力。

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