Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis
Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis
复制标题
DOI：
10.1053/apmr.2001.26812
复制
发表时间：
2001-12-01
影响因子：
4.3
通讯作者：
Allard, P
中科院分区：
文献类型：
--
作者：
Watelain, E;Dujardin, F;Allard, P
目的：目的：研究早期髋关节骨关节炎（OA）患者的骨盆和下肢其他关节是否发生代偿性活动。设计：非随机、病例对照研究。地点：步态实验室。参与者：17例髋关节OA患者。（临床组）与17名健康老年人匹配干预：当受试者走10米的走道两次并跨过一个力板时获得视频数据。主要结果测量：四个相位和时间步态参数（步行速度、站立阶段相对持续时间、步幅、步频）（骨盆倾斜度、灵活性、蹬地最大活动度时的旋转，所有3项）和髋关节（蹬离时的3个髋关节角度，最大髋关节屈曲）运动学参数，3个髋关节力矩和27个三维峰值肌肉功率在步态周期中，下肢关节（标记为关节、峰值功率、平面）发生变化。临床组受试者的特征是步行速度减慢12.4%。临床组的骨盆在推出时比非临床组更向上倾斜（2.5倍）。在额状面测量的倾斜度显示，在蹬离时，临床组的无支撑肢体的骨盆下降更多（2.4倍）。在矢状面中，临床组受试者在第二髋峰值功率中吸收的用于减速大腿伸展的能量较少，并且产生的髋拉力（第三髋峰值功率）分别比非临床组少34%和29%。在矢状面中，临床组在脚跟着地后不久伸直关节的第二膝关节峰值功率降低57%，蹬地时膝关节吸收（第三峰值功率）降低43%。在蹬地阶段，临床组在额状面的第三峰值膝关节力量是非临床组的峰值膝关节力量的两倍以上，在横面的第三峰值膝关节力量是非临床组的峰值膝关节力量的5倍以上，试图控制膝关节内收并通过内旋促进体重转移。在摆动阶段结束时，矢状面中的第四峰值功率显示了腿部减速所需的吸收功率;临床组的吸收功率降低了35%，这代表了通过延长步长来提高步行速度的策略。结论：即使在髋关节OA的早期阶段，通过增加骨盆运动和肌肉发电或其他下肢关节的吸收修改来补偿关节退化。
Objective: To determine if compensatory actions take place at the pelvis and other joints of the affected lower limb in subjects who were in an early stage of hip osteoarthritis (OA).Design: Nonrandomized, case-control study.Setting: A gait laboratory.Participants: Seventeen patients with OA of the hip (clinical group) matched with 17 healthy elderly subjects (nonclinical group).Interventions: Video data obtained while subjects walked a 10-meter walkway twice and stepped across a forceplate.Main Outcome Measures: Four phasic and temporal gait parameters (walking speed, stance phase relative duration, stride length, cadence) 10 pelvic (pelvic tilt, obliquity, rotation at push-off maximum range of motion for all 3) and hip (3 hip angles at push-off, maximum hip flexion) kinematic parameters, 3 hip moments, and twenty-seven 3-dimensional peak muscle powers (labeled by joint, peak power, plane) developed in the lower limb joints during the gait cycle.Results: Subjects in the clinical group were characterized by a 12.4% slower walking speed. The pelvis was more upwardly tilted (2.5 times) at push-off in the clinical group than in the nonclinical group. Obliquity, measured in the frontal plane, revealed that the pelvis dropped more (2.4 times) on the unsupported limb of the clinical group at push-off. In the sagittal plane, subjects in the clinical group absorbed less energy in their second hip peak power for decelerating the thigh extension and generated less hip pull (third hip peak power) than the nonclinical group by 34% and 29%, respectively. In the sagittal plane, the clinical group had 57% lower second knee peak power to straighten the joint shortly after heel strike, and 43% less knee absorption (third peak power) at push-off. During the push-off phase, the clinical group developed more than twice their third peak knee power in the frontal plane and 5 times more their third peak knee power in the transversal plane than the peak knee power of the nonclinical group in an attempt to control knee adduction and to facilitate body-weight transfer by an internal rotation. At the end of the swing phase, the fourth peak power in the sagittal plane showed the absorption power required to decelerate the leg; it was reduced by 35% in the clinical group, representing a strategy to increase walking speed by lengthening the stride length.Conclusions: Even at an early stage of hip OA, joint degeneration was compensated by an increase in pelvis motion and muscle power generation or absorption modifications in other lower limb joints.