步态分析法评价发育性髋关节脱位手术治疗后的功能

目的 通过三维步态分析的生物力学方法评价发育性髋关节脱位手术治疗后的患儿步态功能.方法 选择2010年5月至2012年11月广州市妇女儿童医疗中心22例(27侧)手术治疗的髋关节脱位患儿,年龄3～10岁,平均5.3岁;男9例,女13例.开放复位后18个月,应用美国mo-tion公司三维运动分析系统进行步态分析.每次测量要求至少有3个步长长度,步速恒定.将骨盆、髋、膝、踝关节共设置15个点,并连接成面,建成三维动态图像.结果 手术后骨盆、髋关节、膝关节、踝关节活动与正常儿童比较存在统计学差异.单侧患儿术后患侧骨盆高度较健侧低;骨盆前倾不足;患侧髋关节在术后屈曲不足,并且有明显外旋,术后双膝摆动相屈膝峰值降低;患侧足轻度内旋.术后在行走过程中三联截骨组骨盆较Pemberton截骨组与Salter截骨组显著下降;骨盆在Pemberton截骨组较Salter截骨组显著前倾和向患侧旋转;行走速度、步频、步长与正常儿童比较无明显差异.手术髋站立前中期伸髋力矩减小,产能减少.结论 发育性髋关节脱位开放手术后患儿的速度、步频、步长与正常儿童无差异.在整个步态周期中,术侧髋关节屈曲不足;在负重期患侧骨盆降低,骨盆降低程度三联截骨较pemberton截骨与salter截骨程度更大.

Postoperative gait analyses for developmental dislocation of the hip

Objective To explore the gait function of surgical patients with developmental dislocation of the hip (DDH) via a three-dimensional (3D) biomechanical approach.Methods Twenty-two surgical patients of DDH were selected between May 2010 and November 2012.There were 9 males and 13 females with an average age of 5.3 (3 10) years.At 18 months post-operation, they were evaluated by 3D gait motion analysis system (Motion Inc., USA).And three step lengths at a constant gait speed were measured.Fifteen points were selected around pelvis, hip, knee and ankle and connected for acquiring 3D dynamic images.Results Compared with control group, the patient movements of pelvis, hip, knee and ankle were obviously different.In unilateral ones, postoperative pelvic heights were higher than contralateral counterparts and anterior pelvic tilt was slightly insufficient.Postoperative hip had those of less abduction and flexion and more external than those of control group.The postoperative flexion peak for both knees declined during swing phase.The postoperative ipsilateral foot had more internal rotation.Pelvis of triple pelvic osteotomy group was lower than those of Salter and Pemberton groups.And anterior pelvic tilt was worse in Pemberton group than that in Salter group.Walking speed, cadence and step showed no significant difference with normal children.And the extension moment of postoperative hips decreased and capacity declined.Conclusions Walking speed, cadence and step of DDH patients after operation show no significant difference compared with normal controls.However, during whole gait cycle, hip flexion is insufficient;pelvis was lower during weight-bearing period.Moreover, pelvis of triple pelvic osteotomy is lower than those of pemberton and salter groups.