全髋表面置换与金属对金属大直径股骨头全髋置换术后的步态分析比较

摘要

目的 比较全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术患者术后1年的步态有无差异.方法 选择2006年6月至2009年3月期间行全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术的连续病例各30例,利用Vicon步态分析仪测得两组患者术后平均1年左右的步态参数和步态周期中的髋、膝关节活动度,计算自身患侧/健侧比值进行比较分析.结果 两组患者术后平均1年左右步频、单腿支撑时间等比值和美国特种外科医院评分及加州大学洛杉矶分校评分比较差异无统计学意义,但全髋关节表面置换组患者步态周期中的髋屈伸度、收展度、旋转度及膝关节屈伸度患/健比分别为1.0323、0.9747、1.0558、1.0027,明显高于大直径股骨头全髋关节置换组(患/健比分别为0.8615、0.7824、0.8162、0.9472),P值分别为0.007、0.005、0.006、0.037.结论 (1)全髋关节表面置换术与金属对金属大直径股骨头全髋关节置换术患者术后1年的步态参数接近正常;(2)全髋关节表面置换术后患者行走时的关节活动度优于金属对金属大直径股骨头全髋关节置换术患者;(3)采用全髋关节表面置换除了能够保留骨量,还能最大程度恢复患者的关节功能.%Objective To compare gait patterns in patients with metal-on-metal resurfacing hip arthroplasty(RHA)and big-femoral-head total hip arthroplasty(BHA)at one year postoperatively.Methods From June 2006 to March 2009,two groups of 30 RHA and BHA patients participated in the study.Gait parameters,knee and hip joint range of motions(ROMs)in gait cycles were measured at one year postoperatively by Vicon gait analysis system,and the values were used to calculate affected/unaffected ratios of patients themselves.Results No significant difference were found in affected/unaffected ratios of cadence,single limb support time,foot off,peak value of vertical ground reaction force,the hospital for special surgery score and the university of California at Los Angeles activity assessment between the two groups.However,several ROM affected/unaffected ratios in RHA group(hip range of flexion/extension,abduction/adduction,and rotation were 1.0323,0.9747,and 1.0558,respectively.The knee range of flexion/extension for affected/unaffected ratios was 1.0027)were significantly higher than those in BHA group(the corresponding values were 0.8615,0.7824,0.8162,0.9472,respectively).The P values were 0.007,0.005,0.006,and 0.037,respectively.Conclusion(1)Gait parameters of patients who underwent RHA and BHA were close to normal values at one year postoperatively.(2)At the follow up time point,joint ROMs of RHA patients are larger than those of BHA patients during gait cycle.(3)RHA can retain enough bone stock for future revision option,moreover,it can achieve maximum recovery of joint function.