不同入路人工全髋关节置换后步态及髋关节活动能力的比较. (Chinese)

Comparison of gait and hip ambulation ability after total hip arthroplasty through different approaches. (English)

BACKGROUND: In the selection of minimally invasive total hip arthroplasty approaches, there is considerable debate about whether direct anterior and posterior approaches differ in postoperative gait, limb balance, and hip motor capacity, and therefore further investigation is warranted. OBJECTIVE: To assess the gait and hip ambulation ability of direct anterior and posterior approaches for primary unilateral total hip arthroplasty with a prospective randomized controlled study. METHODS: A total of 61 patients with unilateral avascular necrosis of the femoral head in Qingdao Municipal Hospital from January 2019 to June 2020 were included in the study. There were 40 males and 21 females, at a mean age of (64.83±5.52) years. All the patients were randomly divided into a direct anterior approach group (n=28) and a posterior approach group (n=33), and received initial total hip arthroplasty by direct anterior approach and posterior approach, respectively. Gait analysis (gait time-space parameters such as stride length, stride frequency, single-leg support time, and plantar pressure difference) and hip ambulation ability (standing-walking timing test and 2-minute walking test) were performed before and 1, 3 and 6 months after operation. RESULTS AND CONCLUSION: (1) With the extension of postoperative time, gait time-space parameters in both groups were gradually improved. The stride length, stride frequency, single-leg support time, and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 1 month after surgery (P < 0.01). The stride frequency, single-leg support time, and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 3 months after surgery (P < 0.05). The plantar pressure difference in the direct anterior approach group was significantly better than that in the posterior approach group 6 months after surgery (P < 0.01). (2) With the extension of postoperative time, the results of the standing-walking timing test and 2-minute walking test were gradually improved in both groups. The results of the standing-walking timing test and 2-minute walking test 1 and 3 months after operation in the direct anterior approach group were better than those in the posterior approach group (P < 0.05). (3) The results have indicated that the recovery of postoperative gait and hip ambulation ability of the two groups is inconsistent. The direct anterior approach group has some advantages in the improvement of postoperative gait and hip ambulation ability compared with the posterior approach group in the early postoperative period. [ABSTRACT FROM AUTHOR]

背景: 在微创全髋关节置换手术入路的选择上, 有关直接前入路与后侧入路在术后步态、肢体平衡及髋部运动能力方面是否存在差异还有 很大争议, 因此, 有必要进行进一步的研究。 目的: 采用前瞻性随机对照研究的方法评估直接前入路与后侧入路人工全髋关节置换后早期患者的步态及髋关节活动能力恢复情况。 方法: 纳入 2019 年 1 月至 2020 年 6 月青岛市市立医院收治的单侧股骨头坏死患者 61 例, 其中男 40 例, 女 21 例, 平均年龄 (64.83±5.52) 岁, 采 用随机数字表法分为直接前入路组 (n=28) 与后侧入路组 (n=33), 分别经直接前入路、后侧入路进行初次人工全髋关节置换手术。术前及术 后 1, 3, 6 个月对患者进行步态分析(步长、步频、单足支撑时间、足底压力差等步态时间-空间参数)及髋关节活动能力(站立-行走计时测 试与 2 min 步行测试)测评。 结果与结论: ① 随着术后时间的延长, 两组患者的步态时间-空间参数逐步改善, 直接前入路组患者术后 1 个月的步长、步频、单足支撑时 间、足底压力差测试结果均显著优于后侧入路组 (P<0.01), 术后 3 个月的步频、单足支撑时间、足底压力差测试结果显著优于后侧入路组 (P<0.05), 术后 6 个月的足底压力差测试结果优于后侧入路组 (P<0.01); ② 随着术后时间延长, 两组患者的站立-行走计时测试及 2 min 步行 测试结果逐步改善, 直接前入路组患者术后 1, 3 个月的站立-行走计时测试及 2 min 步行测试结果优于后侧入路组 (P<0.05); ③ 结果显示, 两组患者术后步态和髋关节活动能力恢复情况不一致, 直接前入路组患者术后早期步态和髋关节活动能力优于后侧入路组。 [ABSTRACT FROM AUTHOR]

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