Lee Wei-Chun, Lee Pei-An, Chen Tsan-Yang, Chen Yu-Ting, Wu Kuan-Wen, Tsai Yu-Lin, Wang Ting-Ming, Lu Tung-Wu
Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Front Bioeng Biotechnol. 2022 Mar 24;10:854818. doi: 10.3389/fbioe.2022.854818. eCollection 2022.
Avascular necrosis of the hip (AVN) is one of the most severe complications of surgical reduction when treating developmental dysplasia of the hip (DDH). The current study identified the differences in the balance control during walking in terms of the inclination angle (IA) of the center of pressure (COP) to the center of mass (COM), and the rate of change of IA (RCIA) between female juveniles with and without secondary AVN at the hip who were treated for unilateral DDH during toddlerhood as compared to their healthy peers. When compared to female healthy controls, the non-AVN group showed bilaterally similar compromised balance control with significantly decreased IA ( < 0.05) but increased RCIA ( < 0.04) in the sagittal plane during single-limb support (SLS) of the unaffected side, and in the frontal plane during terminal double-limb support (DLS) of the affected side. In contrast, the AVN increased between-side differences in the sagittal IA ( = 0.01), and sagittal and frontal RCIA during DLS ( < 0.04), leading to bilaterally asymmetrical balance control. Secondary AVN significantly reduced IA and RCIA in the sagittal plane ( < 0.05), and reduced range of RCIA in the frontal plane during initial DLS ( < 0.05). The trend reversed during terminal DLS, indicating a conservative COM-COP control in the sagittal plane and a compromised control in the frontal plane during body weight acceptance, with a compromised COM-COP control in the frontal plane during weight release. The current results suggest that increased between-side differences in the sagittal IA, and sagittal and frontal RCIA during DLS are a sign of AVN secondary to treated unilateral DDH in female juveniles, and should be monitored regularly for early identification of the disease.
髋关节缺血性坏死（AVN）是治疗发育性髋关节发育不良（DDH）时手术复位最严重的并发症之一。本研究确定了在幼儿期接受单侧DDH治疗的患有和未患有继发性髋关节AVN的女性青少年与健康同龄人相比，行走时压力中心（COP）相对于质心（COM）的倾斜角度（IA）以及IA变化率（RCIA）在平衡控制方面的差异。与健康女性对照组相比，非AVN组在患侧单腿支撑（SLS）期间矢状面以及患侧终末双腿支撑（DLS）期间额状面，双侧平衡控制均受损，矢状面IA显著降低（<0.05），但RCIA增加（<0.04）。相比之下，AVN增加了矢状面IA的侧间差异（=0.01），以及DLS期间矢状面和额状面的RCIA（<0.04），导致双侧平衡控制不对称。继发性AVN显著降低了矢状面的IA和RCIA（<0.05），并在初始DLS期间降低了额状面的RCIA范围（<0.05）。在终末DLS期间趋势相反，表明在体重接受过程中矢状面COM-COP控制保守，额状面控制受损，在体重释放期间额状面COM-COP控制受损。目前的结果表明，DLS期间矢状面IA以及矢状面和额状面RCIA的侧间差异增加是女性青少年单侧DDH治疗后继发性AVN的一个迹象，应定期监测以早期识别该疾病。
