髋关节疾病引起骨盆倾斜的原因分析

发布时间：2018-09-04 14:41

【摘要】：目的：通过分析髋关节疾病引起冠状面骨盆倾斜(pelvic tilt, PT)的原因和临床特点,研究其发生的规律性,探讨符合此类疾病特征的骨盆倾斜的分类方法。方法：回顾性分析昆明医科大学第一附属医院骨科2012年1月至2014年12月单侧髋关节疾病引起冠状面骨盆倾斜的180例患者,包括非创伤性股骨头坏死(non-traumatic osteonecrosis of femoral head, NOTONFH)99例、髋关节原发性骨性关节炎(primary osteoarthritis of hip-joint, POAH)32例、发育性髋关节发育不良(developmental dysplasia of hip-joint, DDH)22例、类风湿性髋关节炎(rheumatoid arthritis of hip-Joint, RAH)17例、感染性髋关节炎(infectious hip osteoarthritis, IHOA)10例,对患者进行一般情况、全身情况、髋关节局部情况及影像学资料等的综合评估。通过采集病史,追溯病情进展、演变情况,了解发病缓急、临床表现及生活质量；详细评价髋关节的外观情况、畸形特征、WHO疼痛分级及关节活动度,以此评估髋关节功能,明确患侧髋关节功能改变的类型与机理；通过检测骨盆倾斜的方向、度数及双侧棘踩线、脐踝线的长度,明确骨盆倾斜及患肢短缩的程度,并结合患侧髋关节功能改变后的畸形类型,分析发生冠状面骨盆倾斜的原因,研究其规律性、探讨符合此类疾病特征的骨盆倾斜的分类方法。结果：1 180例髋关节疾病引起骨盆倾斜的临床特点：(1)骨盆向患侧肢体倾斜,称之为Ⅰ型骨盆倾斜,共37例。患侧髋关节不同程度的屈曲、外展挛缩畸形,患肢可持重、行走,行走时患侧髋关节屈曲、外展,对侧肢体内收,骨盆向患侧肢体倾斜。病程进展缓慢,髋关节疼痛较轻,以进行性加重的关节活动功能障碍为主要临床表现。(2)骨盆向对侧肢体倾斜,称之为Ⅱ型骨盆倾斜,共143例。患侧髋关节不同程度的屈曲、内收挛缩畸形,患肢持重、行走功能较差,行走时患侧髋关节屈曲、内收,对侧肢体外展,骨盆向对侧肢体倾斜。病程进展较快,发病时及病程中以髋关节疼痛为主要临床表现。2采用SPSS20.0软件,对不同病因、不同髋关节疼痛分级的骨盆倾斜类型构成比的差异进行x2检验,当条件不满足时采用fisher精确检验。结果发现：(1)不同病因的骨盆倾斜类型构成比有显著性差异(fisher精确值=40.267,p0.05),即不同病因与骨盆倾斜类型有相关性,并发现非创伤性股骨头坏死、髋关节原发性骨性关节炎、类风湿性髋关节炎和感染性髋关节炎倾向于发生Ⅱ型骨盆倾斜；(2)不同疼痛分级的骨盆倾斜类型构成比存在显著性差异(fisher精确值=96.739,p0.05),即疼痛分级与骨盆倾斜类型有相关性,并发现疼痛分级越高,Ⅱ型骨盆倾斜的比例越高,即倾向于发生Ⅱ型骨盆倾斜。结论：1如髋关节疾病病程中疼痛较轻,关节活动功能障碍进行性加重,患侧髋关节多发生屈曲、外展挛缩畸形,骨盆向患侧肢体倾斜；如疼痛较重,髋关节多发生屈曲、内收挛缩畸形,骨盆向对侧肢体倾斜。2单侧髋关节疾病引起冠状面骨盆倾斜的方向始终与躯体重心的移向一致,即均向外展侧肢体倾斜；患肢短缩并不能决定骨盆倾斜的方向。3根据患侧髋关节挛缩畸形的类型及患肢是否短缩,将骨盆倾斜分类如下：Ⅰ型：患侧髋关节外展挛缩型ⅠA型：双侧棘踝线等长ⅠB型：双侧棘踝线不等长Ⅱ型：患侧髋关节内收挛缩型ⅡA型：双侧棘踝线等长ⅡB型：双侧棘踝线不等长4单侧髋关节疾病引起的冠状面骨盆倾斜,多为Ⅱ型骨盆倾斜。
[Abstract]:Objective: To analyze the causes and clinical features of coronal pelvic tilt (PT) caused by hip joint diseases, to study the regularity of PT and to explore the classification methods of PT. 180 cases of coronal pelvic obliquity caused by arthropathy included 99 cases of non-traumatic osteonecrosis of femoral head (NOTONFH), 32 cases of primary osteoarthritis of hip-joint (POAH), 32 cases of developmental dysplasia of hip-joint (DDH). 22 cases, 17 cases of rheumatoid arthritis of hip-Joint (RAH) and 10 cases of infectious hip osteoarthritis (IHOA) were assessed comprehensively by collecting the history of the disease, tracing the progress of the disease, understanding the evolution of the disease, and understanding the general situation, general condition, local situation of the hip joint and imaging data. Acute onset, clinical manifestations and quality of life; detailed evaluation of hip appearance, deformity characteristics, WHO pain classification and joint mobility, to assess hip function, to determine the type and mechanism of functional changes in the affected side of the hip; pelvic tilt direction, degree and bilateral spine line, umbilical and ankle line length, to determine the pelvic function. The causes of coronal pelvic obliquity were analyzed and the regularity of coronal pelvic obliquity was studied. The classification methods of coronal pelvic obliquity were discussed. Results: The clinical features of 1 180 cases of pelvic obliquity caused by hip joint diseases were as follows: (1) Pelvic obliquity to affected side limb. Body tilt, known as type I pelvic tilt, was found in 37 cases. Hip flexion, abduction contracture deformity, weight bearing, walking, hip flexion, abduction, contralateral extremity adduction, pelvic tilt to the affected side. The course of the disease progressed slowly and the pain of the hip joint was mild to progressively aggravate the joint dysfunction. (2) Pelvic tilt to the contralateral limbs, known as type II pelvic tilt, a total of 143 cases. Hip flexion, adduction contracture deformity, weight bearing, walking function is poor, walking hip flexion, adduction, contralateral extremity abduction, pelvic tilt to the contralateral limbs. The main clinical manifestation was hip pain during the course of treatment. 2 The composition of pelvic tilt type was tested by x2 test with SPSS20.0 software. The results showed that: (1) There were significant differences in the composition of pelvic tilt type among different causes and different grades of hip pain. The exact value was 40.267, p0.05, that is, different etiologies were associated with pelvic tilt type, and non-traumatic necrosis of femoral head, primary osteoarthritis of hip joint, rheumatoid hip arthritis and infectious hip arthritis tended to occur type II pelvic tilt; (2) there was a significant difference in the composition ratio of pelvic tilt type among different pain grades (f) Isher accurate value = 96.739, p0.05), that is, the pain classification and pelvic tilt type is related, and found that the higher the pain classification, the higher the proportion of type II pelvic tilt, that is inclined to type II pelvic tilt. Abduction contracture deformity, pelvic tilt to the affected side of the limb; if more pain, hip flexion, adduction contracture deformity, pelvic tilt to the opposite side of the limb. Direction of tilt: 3. Pelvic tilt was classified according to the type of contracture deformity of the affected hip and whether the affected limb was shortened or not. Type I: Hip abduction contracture type I A: Isometric length of bilateral spine-ankle line I B: Isometric length of bilateral spine-ankle line II: Invariant length of bilateral spine-ankle line II A: Isometric length of bilateral spine-ankle line II B: Isometric length of bilateral spine-ankle line II The lateral pelvis malleolus unequal length 4 is a unilateral hip joint disease caused by coronary pelvic tilt, most of which is type II pelvic obliquity.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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