全髋关节置换手术前后三维步态分析

Three-D gait patterns before and after total hip arthroplasty

目的通过三维步态分析的生物力学方法为全髋关节置换手术前后制定康复治疗方案、评定手术疗效提供客观的依据。方法2006年2月至2007年2月应用三维步态分析系统（东方新锐DVMC-8801三维运动分析系统）对健康自愿者40名（平均年龄55岁）及全髋关节置换手术前后的53例患者进行了步态分析，年龄42～82岁，平均59岁。男性33例，平均身高（172±13）cm，体重（64±11）kg；女性20例，平均身高（155±11）cm；体重（45±11）kg。每次测量要求至少有3个步长长度，步速恒定。将髋、膝、踝关节共设置16个点，并连接成面，建成三维动态图像。对全髋置换手术前后的步态在三维方向进行步态分析。结果全髋关节置换手术前后三维步态分析结果：（1）行走速度、步频、步长及患肢站立相术后较术前均有明显改善（P〈0．01），术后1年步态分析各参数基本达到正常水平。（2）术后患肢站立相较术前明显延长。（3）角度时间曲线：术前髋关节最大曲度为15°，后伸为8°，膝关节最大屈曲度70°，踝关节最大屈曲度15°。术后髋关节最大屈曲度为27°，后伸17°，膝关节最大屈曲度50°，踝关节最大屈曲度14°；髋、膝与术前相比差异有统计学意义（P〈0．01）。（4）加速度时间曲线：术后6个月患肢前、后足前后方向加速度的站立相负波及棘波较术前明显减小，摆动相术后出现双峰波，术前为3个正相波。结论运用三维步态分析对行全髋置换术的患者进行功能量化评价，可以更为准确地了解髋关节的生物力学变化，进而探索最佳的治疗手段和手术后的康复方法。

Objective To determine how selected gait parameters may change as a result-of total hip arthroplasty （THA）. Methods From February 2006 to February 2007 the study was performed on 53 osteonecrosis of femoral head subjects prior to and 6 weeks, 3, 6 and 12 months after total hip arthroplasty surgery. Gait analysis was performed using the three-dimensional Infrared-based system （ Dalian Dong Fang Xin Rui Company, China）. Kinematic data were recorded for the lower limb. The results obtained from the osteonecrosis of femoral head subjects were compared with those of 40 individuals without osteonecrosis. Using a three-dimensional motion analyzer, the following were measured： （1） gait speed, stride length, cadence ; （2） step length, stride width ; （ 3 ） standing phase time, walking phase time ; （4） gait cycle time, Joint movement angular. Results Compared with persons before total hip arthroplasty, THA patients showed significantly increased gait speed, gait frequency, step length and affected limb stand phase （P 〈 0.01 ）. Angle timetable： preoperative hip-maximum flexion was 15°, post-extention was 8°, kneemaximum flexion was 70°, ankle-maximum flexion was 15°. Postop hip-maximum flexion was 27, postextention was 17° ,knee-maximum flexion was 50° ,ankle-maximum flexion was 14° ;parameters of hip, knee between preoperative and postoperative was significance（P 〈 0. 01 ）. Conclusion These results suggest that 3-D gait analysis before and after total hip arthroplasty can evaluate precisely hip vitodynamics variation.