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赵江莉,毛玉瑢,邬培慧,廖威明,黄东锋.单侧全髋关节置换术后患者下肢三维运动力学特征分析[J].中国康复医学杂志,2013,28(10):909~913
单侧全髋关节置换术后患者下肢三维运动力学特征分析    点此下载全文
赵江莉  毛玉瑢  邬培慧  廖威明  黄东锋
中山大学附属第一医院康复医学科,广州,510080
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DOI:
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摘要:
      摘要 目的:分析单侧全髋关节置换术(THR)恢复期患者平地步行中下肢关节的三维运动学和动力学特征,指导后续和早期康复。 方法:采用运动重建实验室检测病例数据库资料分析的方法,选择在本院关节外科行THR后5—10年的患者14例为实验组,14例相匹配的健康人为对照组。采用Vicon Nexus、AMTI检测下肢三维运动学和动力学,应用Polygon分析步态周期中髋、膝、踝关节三维运动学和动力学特征。 结果:和对照组右侧下肢比较,术侧髋关节屈曲峰值力矩减小(P<0.05),膝、踝关节屈曲峰值力矩增大(P<0.05);峰值角度方面,术侧髋关节内收、内旋、外旋、后伸和膝关节内收以及踝关节内收、外展、内旋、外旋,差异有显著性意义(P<0.05)。术侧和健侧比较无显著性差异(P>0.05)。 结论:髋关节置换术后恢复期患者,通过同侧膝关节和踝关节屈曲力矩增加代偿患髋屈曲力矩的降低;同时为防止植入物松动和向外脱位,步行中患髋过度外旋并发踝关节过度内旋。另外,健侧下肢产生了与患侧下肢相似的运动力学变化。
关键词:全髋关节置换术  运动学  动力学  步态分析
Analysis of three-dimensional kinematies and kinetic of lower limbs in patients with unilateral total hip replacement    Download Fulltext
Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080
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Abstract:
      Abstract Objective:To investigate three-dimensional kinematics and kinetics of joints of operated lower limbs during walking in patients following unilateral total hip replacement(THR), and to guide physical rehabilitation. Method:Fourteen patients who underwent unilateral THR 5—10 years ago and 14 matched healthy controls were recruited. Vicon system and AMTI force plates were used in gait capture. All three-dimensional kinematic and kinetic parameters of joints of lower limbs were analyzed with Ploygon. Result:Significant decrease of the operated hip flexion moment was observed together with a significant increase of ipsilateral knee flexion and ankle plantar flexion(P<0.05); significant decrease of the operated hip motions were concomitant with significant increase of ipsilateral ankle motions(P<0.05), compared to that of healthy controls. There was no significant difference between operated and non-operated lower extremities neither in kinematic nor kinetics(P>0.05). Conclusion: In patients at recovery stage after THR the operated hip flexion moment decreased compensated with increase of ipsilateral knee flexion and ankle plantarflexion, meanwhile affected hip excessive external rotation accompanied with ipsilateral ankle excessive internal rotation to reduce the risk of implant loosening and dislocation. In addition,the contralateral lower limbs had similar changes in kinematics and kinetics with the operated limbs.
Keywords:total hip replacement  kinematic  kinetic  gait analysis
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