中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (18): 2846-2851.doi: 10.12307/2024.034

• 人工假体 artificial prosthesis • 上一篇    下一篇

不同入路人工全髋关节置换后步态及髋关节活动能力的比较

潘云春1，卫红军2，任国清3，张其亮3   

  1. 1平度市人民医院骨科，山东省青岛市   266700；2青岛市市立医院(东院区)，山东省青岛市   266071；3青岛市市立医院关节与运动医学科，山东省青岛市   266071
  • 收稿日期:2023-02-14 接受日期:2023-04-04 出版日期:2024-06-28 发布日期:2023-08-24
  • 通讯作者: 张其亮，副主任医师，青岛市市立医院关节与运动医学科，山东省青岛市 266071
  • 作者简介:潘云春，男，1972年生，青岛市平度市人，汉族，副主任医师，主要从事骨科方面的研究。
  • 基金资助:
    青岛市2019年度医药科技指导计划项目(2019-WJZD020)，项目负责人：张其亮

Comparison of gait and hip ambulation ability after total hip arthroplasty through different approaches

Pan Yunchun1, Wei Hongjun2, Ren Guoqing3, Zhang Qiliang3   

  1. 1Department of Orthopedics, Pingdu People’s Hospital, Qingdao 266700, Shandong Province, China; 2Qingdao Municipal Hospital (East Ward), Qingdao 266071, Shandong Province, China; 3Department of Joint and Sports Medicine, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China
  • Received:2023-02-14 Accepted:2023-04-04 Online:2024-06-28 Published:2023-08-24
  • Contact: Zhang Qiliang, Associate chief physician, Department of Joint and Sports Medicine, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China
  • About author:Pan Yunchun, Associate chief physician, Department of Orthopedics, Pingdu People’s Hospital, Qingdao 266700, Shandong Province, China
  • Supported by:
    Qingdao Medical Science and Technology Guidance Program in 2019, No. 2019-WJZD020 (to ZQL)

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摘要：


文题释义：

步态分析：是识别步态特征、研究步行规律的检查方法，其通过生物力学和运动学手段揭示正常或者异常步态中的关键环节及影响因素，从而指导康复评估和治疗，有助于临床诊断、疗效评估及机制研究等。
站立-行走计时测试：是一种快速定量评定功能性步行能力的方法。评定时患者着平常穿的鞋坐在有扶手的靠背椅上(椅子座高约45 cm，扶手高约20 cm)，身体靠在椅背上，双手放在扶手上；在离座椅3 m远的地面上贴一条彩条或划一条可见的粗线或放一个明显的标记物；当测试者发出“开始”的指令后，患者从靠背椅上站起，站稳后按照平时走路的步态向前走3 m，过粗线或标记物处后转身，然后走回到椅子前，再转身坐下，靠到椅背上，测试过程中不能给予任何躯体的帮助。由于该方法简单、容易掌握、应用方便，因此成为了临床人员评定下肢功能的重要手段。


背景：在微创全髋关节置换手术入路的选择上，有关直接前入路与后侧入路在术后步态、肢体平衡及髋部运动能力方面是否存在差异还有很大争议，因此，有必要进行进一步的研究。

目的：采用前瞻性随机对照研究的方法评估直接前入路与后侧入路人工全髋关节置换后早期患者的步态及髋关节活动能力恢复情况。
方法：纳入2019年1月至2020年6月青岛市市立医院收治的单侧股骨头坏死患者61例，其中男40例，女21例，平均年龄(64.83±5.52)岁，采用随机数字表法分为直接前入路组(n=28)与后侧入路组(n=33)，分别经直接前入路、后侧入路进行初次人工全髋关节置换手术。术前及术后1，3，6个月对患者进行步态分析(步长、步频、单足支撑时间、足底压力差等步态时间-空间参数)及髋关节活动能力(站立-行走计时测试与2 min步行测试)测评。

结果与结论：①随着术后时间的延长，两组患者的步态时间-空间参数逐步改善，直接前入路组患者术后1个月的步长、步频、单足支撑时间、足底压力差测试结果均显著优于后侧入路组(P < 0.01)，术后3个月的步频、单足支撑时间、足底压力差测试结果显著优于后侧入路组(P < 0.05)，术后6个月的足底压力差测试结果优于后侧入路组(P < 0.01)；②随着术后时间延长，两组患者的站立-行走计时测试及2 min步行测试结果逐步改善，直接前入路组患者术后1，3个月的站立-行走计时测试及2 min步行测试结果优于后侧入路组(P < 0.05)；③结果显示，两组患者术后步态和髋关节活动能力恢复情况不一致，直接前入路组患者术后早期步态和髋关节活动能力优于后侧入路组。

https://orcid.org/0009-0002-5395-2438 (潘云春) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 直接前入路, 后侧入路, 全髋关节置换术, 股骨头坏死, 步态, 髋关节活动能力

Abstract: BACKGROUND: In the selection of minimally invasive total hip arthroplasty approaches, there is considerable debate about whether direct anterior and posterior approaches differ in postoperative gait, limb balance, and hip motor capacity, and therefore further investigation is warranted.  
OBJECTIVE: To assess the gait and hip ambulation ability of direct anterior and posterior approaches for primary unilateral total hip arthroplasty with a prospective randomized controlled study. 
METHODS: A total of 61 patients with unilateral avascular necrosis of the femoral head in Qingdao Municipal Hospital from January 2019 to June 2020 were included in the study. There were 40 males and 21 females, at a mean age of (64.83±5.52) years. All the patients were randomly divided into a direct anterior approach group (n=28) and a posterior approach group (n=33), and received initial total hip arthroplasty by direct anterior approach and posterior approach, respectively. Gait analysis (gait time-space parameters such as stride length, stride frequency, single-leg support time, and plantar pressure difference) and hip ambulation ability (standing-walking timing test and 2-minute walking test) were performed before and 1, 3 and 6 months after operation. 
RESULTS AND CONCLUSION: (1) With the extension of postoperative time, gait time-space parameters in both groups were gradually improved. The stride length, stride frequency, single-leg support time, and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 1 month after surgery (P < 0.01). The stride frequency, single-leg support time, and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 3 months after surgery (P < 0.05). The plantar pressure difference in the direct anterior approach group was significantly better than that in the posterior approach group 6 months after surgery (P < 0.01). (2) With the extension of postoperative time, the results of the standing-walking timing test and 2-minute walking test were gradually improved in both groups. The results of the standing-walking timing test and 2-minute walking test 1 and 3 months after operation in the direct anterior approach group were better than those in the posterior approach group (P < 0.05). (3) The results have indicated that the recovery of postoperative gait and hip ambulation ability of the two groups is inconsistent. The direct anterior approach group has some advantages in the improvement of postoperative gait and hip ambulation ability compared with the posterior approach group in the early postoperative period. 

Key words: direct anterior approach, posterior approach, total hip arthroplasty, avascular necrosis of the femoral head, gait, hip ambulation ability

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