目的 通过三维步态系统分析人工全髋关节置换术(total hip arthroplasty,THA)后髋关节运动学变化特征.方法 以2022年10月-2023年6月收治的髋关节疾病患者为研究对象,根据选择标准筛选患者(THA组),同期纳入与THA组年龄段相匹配的健康志愿者,作为对照组.比较两组年龄、性别、身体质量指数及侧别,分析可比性.记录THA组患者术前及末次随访时Harris髋关节评分(HHS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分.采用三维运动捕捉系统采集受试者步行状态下时空参数和运动学数据,包括下肢步长、步频以及髋关节外展/内收、外旋/内旋和屈曲/伸展三自由度最大值、最小值、活动范围(range of motion,ROM),以及步态评分,比较两组差异.同时,分析THA组患者步态评分与术后HHS、WOMAC评分相关性.最后,将收集的各自由度运动学数据拟合生成步态图,对髋关节三自由度在步态周期中的动态变化进行量化研究.结果 两组各纳入20例受试者,其性别、年龄、侧别及身体质量指数差异均无统计学意义(P＞0.05).THA患者术后随访时间为6～12个月,平均9.9个月.THA组患者末次随访时HHS评分及WOMAC评分较术前改善,差异有统计学意义(P＜0.05);步态评分与术后HHS评分成正相关(r=0.585,P=0.007)、与WOMAC评分成负相关(r=-0.619,P=0.004).THA组术后步长、步频与对照组差异无统计学意义(P＞0.05),但步态评分低于对照组且差异有统计学意义(P＜0.05).两组屈曲/伸展、外旋/内旋、外展/内收最大值及最小值差异均无统计学意义(P＞0.05);但THA组ROM均小于对照组,差异有统计学意义(P＜0.05).在步态周期多个时相中,两组屈曲/伸展自由度存在明显差异(P＜0.05).结论 相较于正常人群,THA患者术后早期髋关节在步态周期中呈相对内收、外旋、屈曲位,三自由度的运动学参数仍未完全恢复;在步态周期多个时相中髋关节屈曲度与正常人有明显差异.
Analysis of kinematic changes of hip joint after total hip arthroplasty
Objective To analyze the kinematic changes of the hip joint after total hip arthroplasty(THA)through three-dimensional gait analysis.Methods Patients with hip joint diseases admitted between October 2022 and June 2023 were selected as the subjects.The patients who met the selective criteria were finally included in the THA group.The healthy volunteers matched with the THA group in the same age were included as the control group.Baseline data including age,gender,body mass index(BMI),and laterality were compared between the two groups.The Harris hip score(HHS)and the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score were recorded preoperatively and at last follow-up in the THA group.Three-dimensional motion capture system was utilized to collect spatiotemporal parameters and kinematic data during walking,including stride length,cadence,and maximum/minimum values,range of motion(ROM)in hip joint abduction/adduction,external/internal rotation,and flexion/extension,as well as gait scores.Differences between the two groups were analyzed.Additionally,the correlation between gait scores and postoperative HHS and WOMAC scores were analyzed in the THA group.Finally,the kinematic data of each degree of freedom(DOF)were fitted into a gait diagram,and the dynamic changes of the 3-DOF of the hip joint during the gait cycle were quantitatively analyzed.Results There was no significant difference in gender,age,laterality,and BMI between the two groups(n=20,P＞0.05).The mean follow-up time in the THA group was 9.9 months(range,6-12 months).The HHS and WOMAC scores at last follow-up in the THA group showed significant improvement when compared with preoperative scores(P＜0.05).Gait scores were positively correlated with postoperative HHS score(r=0.585,P=0.007)and negatively correlated with WOMAC score(r=-0.619,P=0.004).There was no significant difference in stride length and cadence between the THA and control groups(P＞0.05),but gait score was significantly lower in the THA group than in the control group(P＜0.05).There was no significant difference in maximum and minimum values of flexion/extension,external/internal rotation,and abduction/adduction between the two groups(P＞0.05);however,ROM in the THA group was significantly lower than that in the control group(P＜0.05).There were significant differences between the two groups of flexion/extension in multiple phases of the gait cycle(P＜0.05).Conclusion Early post-THA hip joint kinematics exhibit relative adduction,external rotation,and flexion during the gait cycle compared to normal individuals,with incomplete recovery of kinematic parameters in three degrees of freedom.Significant differences in flexion are observed at multiple phases of the gait cycle compared to normal individuals.
Total hip arthroplastythree-dimensional gait analysiskinematics
NETL
NSTL
万方数据
