Fujita Tsutomu, Hamai Satoshi, Hara Daisuke, Kawahara Shinya, Yamaguchi Ryosuke, Ikemura Satoshi, Motomura Goro, Kawaguchi Kenichi, Nakashima Yasuharu
Department of Rehabilitation, Kyushu University Hospital, Fukuoka, Japan.
Department of Orthopedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Orthop. 2024 Jul 30;59:57-63. doi: 10.1016/j.jor.2024.07.020. eCollection 2025 Jan.
Despite experiencing pain relief and improved activities of daily living after total hip arthroplasty (THA) for osteoarthritis of the hip, a Trendelenburg gait may be observed in some patients. The concentric and eccentric contraction patterns of hip muscles in a Trendelenburg gait are not well understood.
This study included 89 patients (28 males and 61 females, mean age 66.5 ± 8.4 years, mean postoperative period 1.3 ± 0.4 years) after unilateral THA without functional impairment on the contralateral side. Gait analysis utilized a three-dimensional motion capture system to assess pelvis and hip angles, hip moment, and hip power. A Trendelenburg gait was defined as positive when nonoperative pelvic descent occurred at 30 % of the gait cycle, equivalent to mid-stance. Patients were classified into Trendelenburg gait-positive and -negative groups for statistical analysis. Unpaired -test and chi-square test were used to compare the two groups. Multiple regression analysis was conducted to identify factors associated with the presence of a Trendelenburg gait.
A Trendelenburg gait was observed in 24 patients (27 %). Multiple regression analysis indicated that abduction (p < 0.01) and extension (p = 0.03) of hip joint power were significant determining of a Trendelenburg gait. Patients with a Trendelenburg gait exhibited reduced eccentric contraction of the hip abductor muscles and decreased concentric contraction of hip extensor muscles during early to mid-stance of their gait.
Centrifugal contraction of hip abductor muscles and diminished eccentric contractility of hip extensor muscles appear crucial for hip stabilization mechanisms during gait after THA.
尽管因髋关节骨关节炎行全髋关节置换术（THA）后患者疼痛减轻且日常生活活动能力得到改善，但部分患者可能仍会出现Trendelenburg步态。目前对Trendelenburg步态中髋部肌肉的向心和离心收缩模式尚不清楚。
本研究纳入89例单侧THA术后患者（男性28例，女性61例，平均年龄66.5±8.4岁，平均术后时间1.3±0.4年），对侧无功能障碍。步态分析采用三维运动捕捉系统评估骨盆和髋关节角度、髋关节力矩和髋关节功率。当在步态周期的30%（相当于站立中期）出现非手术侧骨盆下降时，将Trendelenburg步态定义为阳性。将患者分为Trendelenburg步态阳性组和阴性组进行统计学分析。采用独立样本t检验和卡方检验比较两组。进行多元回归分析以确定与Trendelenburg步态存在相关的因素。
24例患者（27%）出现Trendelenburg步态。多元回归分析表明，髋关节功率的外展（p<0.01）和伸展（p=0.03）是Trendelenburg步态的重要决定因素。Trendelenburg步态患者在步态的早中期，髋外展肌的离心收缩减少，髋伸肌的向心收缩降低。
THA术后步态中，髋外展肌的离心收缩以及髋伸肌离心收缩力的减弱对髋关节稳定机制似乎至关重要。
