人工全髋关节置换术后患者髋关节功能的生物力学分析

Biomechanical analysis of the hip joint functions in patients after total hip joint replacement

目的 :采用生物力学评价方法研究人工全髋关节置换术 (THR)后患者髋部步态动力学和肌力的变化与髋关节功能状态的关系。 方法 :选择单侧THR的患者共 2 5例 ,按术后不同时期分为两组。利用压电晶体式三维测力台和等速极力测试系统 ,观察两组患者健、患侧髋的曲伸肌力变化。 结果 :①步态测试 :术后 1年以内组患者健、患侧的垂直分力 时间积分值差异显著 (P <0 .0 5 )。②等速肌力测试 :双侧峰力矩值术后 1年以内组健侧屈、伸肌均大于患侧 (P <0 .0 5 )。峰力矩占体重比值术后 1年以内组健侧屈、伸肌均大于患侧 ,差异显著。③临床评价 :患者髋关节Harris评分从术前的 18～ 6 0分提高到术后的 78～ 97分。 结论 :术后生物力学的测定有助于判断髋周肌力的恢复情况。其与临床评价不一致 ,可能更具客观性 ,可作为评价THR后髋关节功能的重要参考指标。

Objectives:To establish the relationship between the hip joint functions and the strength of the hip joint and to compare the results of biomechanical analysis and clinical assessment after unilateral total hip joint replacement(THR). Methods:Twenty five patients receiving unilateral total hip joint replacement were enrolled in this study. The patients were divided into 2 groups according to the follow up time: Gait analysis by using Kistler force plate and isokinetic hip strength by employing isokinetic dynamometer were evaluated. Results:①Gait analysis: The force time curve clearly revealed the discrepancies between the two groups. ②Isokinetic testing: The peak torque values for both flexor and extensor ratios of the healthy hip joints were higher than that in the diseased sides.③ Clinical assessment: The Harris hip joint scores significantly increased from 18～60 points preoperatively to 78～97 points postoperatively. Conclusions:These findings may serve as a reminder that it is inconsistent in assessing the hip joint functions by using the methods of clinical and biomechanical analysis. The latter has a higher precision and sensitivity.It can be regarded as an important parameter in evaluating the hip joint functions after THR.