Ma Zhuyi, Fu Shengxing, Wu Xiangdong, Cao Kaiqi, Tang Hao, Zhou Yixin
Peking University Fourth School of Clinical Medicine, Beijing, China.
School of Sport Science, Beijing Sport University, Beijing, 100084, China.
J Orthop Surg Res. 2025 Apr 17;20(1):387. doi: 10.1186/s13018-025-05789-x.
Patients with end-stage hip disease are classified into distinct spinal-hip types according to sagittal spinal-hip parameters. Each type employs specific compensatory strategies to maintain balance, but the associated alterations in gait patterns remain unclear. This study characterized the gait differences among patients with different spinal-hip types.
This prospective observational study used EOS imaging to obtain full-length sagittal images and classify patients into spinal-hip types. The study included 10 patients in each type (A, B, and C) and 10 healthy controls. Gait analysis was performed to evaluate the spatiotemporal and kinematic parameters, followed by the gait profile score (GPS) analysis. The Kruskal-Wallis test was used to compare relevant parameters across the four groups, with post-hoc comparisons conducted using the Bonferroni method.
Significant differences among the types were observed in stride length (P = 0.003), stance phase percentage (P = 0.001), and swing phase percentage (P < 0.001), with type C showing the shortest stride and type A exhibiting the shortest stance phase. The sagittal range of motion (ROM) of the pelvis and hip varied significantly across the gait cycle (both P < 0.001), with type A exhibiting the largest pelvic ROM and the smallest hip ROM. Types A and C showed lower sagittal center of mass displacement during the stance phase (P < 0.001). Type A exhibited the most restricted knee ROM during the swing phase (P < 0.001). The GPS was highest in type A, followed by type C, while type B and healthy controls had the lowest scores (P < 0.001).
Patients with different spinal-hip types exhibited distinct gait adaptations to compensate for sagittal deformities. Patients with severe sagittal imbalance exhibited compensatory increased pelvic swing and demonstrated diminished functional scores. Preoperative assessment is essential for optimizing total hip arthroplasty outcomes and guiding rehabilitation.
终末期髋关节疾病患者根据矢状位脊柱-髋关节参数被分为不同的脊柱-髋关节类型。每种类型采用特定的代偿策略来维持平衡，但步态模式的相关改变仍不清楚。本研究对不同脊柱-髋关节类型患者的步态差异进行了特征描述。
这项前瞻性观察研究使用EOS成像获取全长矢状位图像，并将患者分为脊柱-髋关节类型。研究包括每种类型（A、B和C）各10例患者以及10名健康对照者。进行步态分析以评估时空参数和运动学参数，随后进行步态轮廓评分（GPS）分析。使用Kruskal-Wallis检验比较四组间的相关参数，采用Bonferroni方法进行事后比较。
在步长（P = 0.003）、站立相百分比（P = 0.001）和摆动相百分比（P < 0.001）方面，各类型之间存在显著差异，C型步长最短，A型站立相最短。骨盆和髋关节的矢状位活动范围（ROM）在步态周期中差异显著（均P < 0.001），A型骨盆ROM最大，髋关节ROM最小。A和C型在站立相期间矢状位质心位移较低（P < 0.001）。A在摆动相期间膝关节ROM受限最明显（P < 0.001）。GPS在A型中最高，其次是C型，而B型和健康对照者得分最低（P < 0.001）。
不同脊柱-髋关节类型的患者表现出不同的步态适应性以代偿矢状位畸形。矢状位严重失衡的患者表现出代偿性增加的骨盆摆动，并显示功能评分降低。术前评估对于优化全髋关节置换术结果和指导康复至关重要。
