髋关节疾病引起骨盆倾斜的原因分析

Cause Analysis on the Pelvic Tilts Induced by Hip-joint Diseases

目的分析髋关节疾病引起骨盆倾斜的原因和特点、规律性及分类方法.方法回顾性分析昆明医科大学第一附属医院2012年1月至2014年12月因髋关节疾病引起骨盆倾斜的180例患者,明确其临床表现、发病缓急、畸形特征及髋关节功能、WHO疼痛分级,比较不同病因、不同疼痛分级的骨盆倾斜类型的构成比是否存在差异,分析其与发生不同类型骨盆倾斜的相关性.结果 (1)37例患者患侧髋关节发生屈曲、外展挛缩畸形,骨盆向患侧肢体倾斜,称为I型骨盆倾斜,病程中髋关节疼痛较轻;143例患者患侧髋关节发生屈曲、内收挛缩畸形,骨盆向对侧肢体倾斜,称为II型骨盆倾斜,病程中髋关节疼痛较重;(2)不同病因、不同疼痛分级的骨盆倾斜类型构成比均存在显著性差异(fisher精确值分别为40.267、96.739,P均小于0.05),即不同病因、不同疼痛分级与发生不同类型的骨盆倾斜存在相关性.结论 (1)如髋关节疾病患者患侧髋关节疼痛较轻,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,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骨盆倾斜的方向始终与躯体重心的移向一致;(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骨盆倾斜多为II型骨盆倾斜.

Objective The aim of this study was to investigate the occurrence patterns and classification method of pelvic tilts （PT） induced by hip-joint diseases via analyzing the causes and clinical features. Methods 180 patients with PT induced by hip-joint diseases who were treated at the department of orthopedics in the first affiliated hospital of Kunming Medical University from January 2012 to December 2014 were analyzed retrospectively. The clinical manifestations, progression, deformity features, hip-joint functions, and WHO pain degree were confirmed, their relationships with different PT types were analyzed, the occurrence patterns and the classification method were investigated. Results （1） There were 37 patients subjected to the type I PT, who were abduction contracture with flexion occurred to the affected hips and their pelvis tilted towards the affected limb. Their pain degrees were relatively low. Besides, the other 143 patients with type I! PT, were abduction contracture with flexion occurred and pelvis tilted towards the contralateral limb. Their pain degrees were relatively heavy. （2） There were significantly differences in PT constituent ratios among different causes and different pain grades （fisher exact value were 40.267 and 96.739, respectively. P〈0.05） . So, causes as well as pain grade were both correlated to the type of PTs. Conclusion （1） If the pain grade is lower, the affected hip joint will mostly bend and show abductioneontraeture malformation with a pelvic tilt towards the affected side. If the pain grade is higher, the affected joint will mostly bend and show adduction contracture malformation with a pelvic tilt towards eontralateral side. （2） The coronal PT direction induced by hip-joint diseases is consistent with the moving direction of body＇s center gravity. （3） According to the types of eontracture malformation and the shortening conditions of the affected limbs, PTs are divided into the following groups： Type I： Abduction eontraeture of the affected hip-joint, including Type IA： with equal bilateral spine-ankle lines （SAL） , and Type In： with unequal bilateral ASL; Type II： Adduction eontraeture of the affected hip-joint, including Type IIA： with equal bilateral SAL, and Type IIR： with unequal bilateral SAL. （4） Coronal PTs induced by unilateral hip-joint diseases are mostly Type II PT.