直接前入路全髋关节置换后早期三维步态分析

发布时间：2018-05-27 13:08

本文选题：关节成形术 + 置换　；参考：《北京大学学报(医学版)》2017年02期

【摘要】：目的:探讨直接前入路(direct anterior approach,DAA)行人工全髋关节置换术后早期效果及患者手术前后的步态变化。方法:20例因股骨头坏死或髋关节发育不良继发骨关节炎的患者于直接前入路下行单侧初次人工关节置换,采集患者一般资料并记录患者术前、术后视觉模拟评分(visual analogue scale,VAS)、Harris评分等,分别于手术前及手术后6周、12周行步态分析,记录并分析患者手术前后步态变化并与正常成人对比。结果:患者术后平均住院时间3.3 d,术后3 d内VAS评分均低于4分,患者假体安放位置满意,至术后12周随访无脱位。步态分析结果中,步速患者组为术前0.64 m/s、术后6周0.77 m/s、术后12周1.07 m/s,正常对照组为1.19 m/s;步频患者组为术前43.15步/min、术后6周51.42步/min、术后12周55.52步/min,正常对照组为57.15步/min;行走时髋关节活动度患者组为术前31.00°、术后6周39.62°、术后12周40.40°,正常对照组为45.67°;行走时膝关节活动度患者组为术前50.52°、术后6周59.28°、术后12周67.29°,正常对照组为70.42°。患者组内比较,除术后6周的步速和行走时膝关节活动度外其他数据差异均有统计学意义;与正常对照组相比,入组患者的步态分析数据仍不及正常对照,术后12周时患者步态数据已接近正常对照组,步速、步频、行走时膝关节活动度结果组间差异无统计学意义。结论:DAA作为全髋关节置换的可选手术入路,患者术后12周步态已接近正常人群,但尚需进一步的更大样本量的研究。
[Abstract]:Objective: to investigate the early effect of direct anterior approach to total hip arthroplasty (THR) and the gait changes of the patients before and after operation. Methods Twenty patients with osteoarthritis secondary to osteonecrosis of femoral head or dysplasia of hip joint underwent unilateral primary arthroplasty via direct anterior approach. The general data of the patients were collected and the visual analogue scores before and after operation were recorded. Gait analysis was performed before operation and 6 weeks and 12 weeks after operation. Gait changes before and after operation were recorded and analyzed and compared with normal adults. Results: the average hospitalization time was 3.3 days, and the VAS score was lower than 4 points within 3 days after operation. The prosthesis placement was satisfactory, and no dislocation was found at 12 weeks after operation. Gait analysis results, The walking rate group was 0.64 m / s before operation, 0.77 m / s at 6 weeks postoperatively, 1.07 m / s at 12 weeks after operation, and 1.19 m / s in normal control group, 43.15 steps per minute before operation, 51.42 steps / min at 6 weeks after operation, 55.52 steps / min at 12 weeks after operation and 57.15 steps / min in normal control group respectively. The range of motion was 31.00 掳before operation, 39.62 掳at 6 weeks after operation, 40.40 掳at 12 weeks after operation, 45.67 掳in normal control group, 50.52 掳before operation, 59.28 掳at 6 weeks after operation, 67.29 掳at 12 weeks after operation and 70.42 掳in normal control group. Compared with the control group, the gait analysis data of the patients were not as good as those of the normal control group, except the walking speed at 6 weeks after operation and the knee joint motion at the time of walking, and the gait analysis data of the patients in the group were not as good as those in the normal control group. At 12 weeks after operation, the gait data of the patients were close to that of the normal control group, and there was no significant difference between the two groups in the results of step speed, gait frequency and knee joint motion during walking. Conclusion as an alternative approach to total hip replacement, the gait of the patients at 12 weeks after operation is close to the normal population, but further research is needed.
【作者单位】：四川大学华西医院骨科;
【基金】：卫生部卫生公益性行业科研专项(201302007)资助~~
【分类号】：R687.4

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