中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (33): 7211-7216.doi: 10.12307/2025.164

• 骨科植入物相关临床实践 Clinical practice of orthopedic implant • 上一篇    下一篇

髋外展肌锻炼对非创伤性股骨头坏死患者三维步态及塌陷率的影响

袁颖嘉1，2，易艳梓1，3，李  津1，2，王  珂1，2，王  煜1，2，林天烨1，2，张庆文1，2，何  伟1，2，魏秋实1，2   

  1. 1广州中医药大学第三附属医院，广东省广州市   510405；2广东省中医骨伤研究院，广东省广州市   510405；3广州中医药大学第三临床医学院，广东省广州市   510080
  • 收稿日期:2024-01-20 接受日期:2024-04-16 出版日期:2025-11-28 发布日期:2025-04-12
  • 通讯作者: 魏秋实，博士，副主任医师，广州中医药大学第三附属医院，广东省广州市 510405；广东省中医骨伤研究院，广东省广州市 510405
  • 作者简介:袁颖嘉，女，1984年生，广东省广州市人，2022年广州中医药大学毕业，硕士，副主任治疗师，主要从事中西医结合治疗股骨头坏死方面的研究。
  • 基金资助:
    国家自然科学基金面上项目 (82274544)，项目负责人：魏秋实；广东省中医药管理局项目(20223012)，项目负责人：张庆文；广东省中医药管理局项目(20233027)，项目负责人：袁颖嘉

Effect of hip abductor muscle exercise on three-dimensional gait and collapse rate in patients with non-traumatic femoral head necrosis

Yuan Yingjia1, 2, Yi Yanzi1, 3, Li Jin1, 2, Wang Ke1, 2, Wang Yu1, 2, Lin Tianye1, 2, Zhang Qingwen1, 2, He Wei1, 2, Wei Qiushi1, 2   

  1. 1Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2Guangdong Provincial Institute of Traditional Chinese Medicine Osteopathy, Guangzhou 510405, Guangdong Province, China; 3Third Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510080, Guangdong Province, China
  • Received:2024-01-20 Accepted:2024-04-16 Online:2025-11-28 Published:2025-04-12
  • Contact: Wei Qiushi, MD, Associate chief physician, Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; Guangdong Provincial Institute of Traditional Chinese Medicine Osteopathy, Guangzhou 510405, Guangdong Province, China
  • About author:Yuan Yingjia, MS, Associate chief therapist, Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; Guangdong Provincial Institute of Traditional Chinese Medicine Osteopathy, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    National Natural Science Foundation of China (General Program), No. 82274544 (to WQS); a grant from Guangdong Provincial Administration of Traditional Chinese Medicine, No. 20223012 (to ZQW); a grant from Guangdong Provincial Administration of Traditional Chinese Medicine, No. 20233027 (to YYJ) 

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摘要：


文题释义：

髋外展肌：主要是由阔筋膜张肌和臀中肌、臀小肌组成，这些肌肉不仅可以外展髋关节，也能在负重运动中起到稳定作用。髋外展肌群的紧张既会造成骨盆平衡失调，引起髋部疼痛，而且也会出现腰痛和膝关节痛。髋关节外展肌肌力训练适用于股骨头坏死患者，加强肌肉锻炼，延缓股骨头塌陷、预防跛行。
三维步态分析：是指运用动作捕捉镜头、测力台、表面肌电图等设备同步采集患者在步行过程中的肢体运动参数。与影像学检查监测静态状态下骨骼、肌肉等的结构形态关系相比，三维步态分析的优势是可以观察人体运动过程中的关节、骨骼、肌肉协调运动情况，通过量化数据客观评估人体的整体运动功能水平，结合影像资料及临床物理评估，可为医生及患者提供客观精确的临床诊疗依据。


背景：非创伤性股骨头坏死是一个疑难的关节疾病，保留自身的股骨头对于年轻的患者而言意义重大，目前尚缺乏规律、统一的保髋功能锻炼方案。

目的：观察髋外展肌锻炼对非创伤性股骨头坏死患者三维步态及塌陷率的影响，为非创伤性股骨头坏死患者有效康复提供理论依据。
方法：纳入2020年6月至2022年6月广州中医药大学第三附属医院收治的非创伤性、非手术性股骨头坏死患者81例81髋，随机将患者分为对照组(n=40)及髋外展肌锻炼组(n=41)。对照组接受常规物理治疗和药物治疗；髋外展肌锻炼组在对照组的基础上进行髋外展肌锻炼。治疗前及治疗后12周，采用Tecnobody平衡评估系统评估两组患者的步态情况(髋关节活动度、步长差值、触地时间差值)；采用BIODEX-S4等速肌力测试系统测试髋外展等速肌力的力矩峰值；对比臀中肌宽度比。治疗后1年对比两组患者股骨头塌陷率的情况。

结果与结论：①两组患者在年龄、性别、侧别、体质量指数、病因等方面相比差异均无显著性意义(P > 0.05)；②治疗前，两组患侧髋关节活动度对比无显著性差异(P > 0.05)；治疗后12周两组患者患侧髋关节活动度均较治疗前改善(P < 0.05)，且髋外展肌锻炼组患侧髋关节活动度显著大于对照组(P < 0.05)；③治疗前，两组患者步长差值、触地时间差值对比无显著性差异(P > 0.05)；治疗后12周两组步长差值、触地时间差值均较治疗前减小(P < 0.05)，且治疗后髋外展肌锻炼组步长差值、触地时间差值显著小于对照组(P < 0.05)；④治疗前，两组患者臀中肌宽度比对比无显著性差异(P > 0.05)；治疗后12周两组臀中肌宽度比均较治疗前增大(P < 0.05)，且治疗后髋外展肌锻炼组臀中肌宽度比显著大于对照组(P < 0.05)；⑤治疗后1年两组患者股骨头塌陷率对比差异有显著性意义(P < 0.05)，髋外展肌锻炼组(22%)显著小于对照组(45%)；⑥提示髋外展肌锻炼可有效改善非创伤性股骨头坏死患者的髋关节功能，改善步态，降低患者股骨头塌陷率，建议将髋外展肌锻炼作为非创伤性股骨头坏死保髋基础方法之一。

https://orcid.org/0009-0005-5242-4635 (袁颖嘉) 

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: 股骨头坏死, 髋外展肌, 步态, 功能锻炼, 塌陷

Abstract: BACKGROUND: Non-traumatic necrosis of the femoral head is a difficult joint disease, and preserving one’s own femoral head is of great significance for young patients. Currently, there is a lack of regular and unified functional exercise plans.
OBJECTIVE: To investigate the effect of hip abductor muscle exercise on the three-dimensional gait and collapse rate of patients with non-traumatic femoral head necrosis, and to provide theoretical basis for effective rehabilitation of patients with non-traumatic femoral head necrosis.
METHODS: Totally 81 non-traumatic and non-surgical patients with femoral head necrosis (81 hips) admitted to the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from June 2020 to June 2022 were included. Patients were randomly divided into a control group (n=40) and a hip abductor muscle exercise group (n=41). The control group received routine physical therapy and medication treatment. The hip abductor muscle exercise group underwent hip abductor muscle exercise on the basis of the control group. The gait status (hip joint range of motion, step length difference, and ground contact time difference) of two groups of patients was evaluated using the Tecnobody balance assessment system before and 12 weeks after treatment. The BIODEX-S4 isokinetic muscle strength testing system was used to test the peak force distance of hip abduction isokinetic muscle strength. Gluteus medius width ratio was compared between two groups. The collapse rate was compared between two groups of patients 1 year after treatment.
RESULTS AND CONCLUSION: (1) There was no statistically significant difference between the hip abductor muscle exercise group and the control group in terms of age, gender, side profile, body mass index, and etiology (P > 0.05). (2) Before treatment, there was no significant statistical difference in the range of motion of the affected hip joint between the two groups (P > 0.05). After treatment, the range of motion of the affected hip joint in both groups improved compared to before treatment (P < 0.05), and the range of motion of the affected hip joint in the hip abductor muscle exercise group was significantly higher than that in the control group (P < 0.05). (3) Before treatment, there was no significant statistical difference in the step length and touchdown time between the two groups (P > 0.05). 12 weeks after treatment, the difference in step length and touchdown time between the two groups decreased compared to before treatment (P < 0.05), and the difference in step length and touchdown time between the hip abductor muscle exercise group after treatment was significantly greater than that of the control group (P < 0.05). (4) Before treatment, there was no significant statistical difference in gluteus medius width ratio between the two groups (P > 0.05). 12 weeks after treatment, the gluteus medius width ratio of both groups increased compared to that before treatment (P < 0.05), and the gluteus medius width ratio of the hip abductor muscle exercise group was significantly higher than that of the control group (P < 0.05). (5) At 1 year after treatment, the comparison of femoral head collapse rates between the two groups showed significant statistical significance (P < 0.05), and that in the hip abductor muscle exercise group (22%) was significantly lower than that in the control group (45%). (6) It is concluded that exercise of the hip abductor muscle effectively enhances hip joint function, improves gait, and reduces the rate of femoral head collapse in patients with non-traumatic femoral head necrosis. It is recommended to use hip abductor muscle exercise as one of the basic methods for hip preservation in non-traumatic femoral head necrosis.

Key words: femoral head necrosis, hip abductor muscle, gait, functional exercise, collapse

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