本文選題：步態(tài)分析 + 足底壓力　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景發(fā)育性髖關(guān)節(jié)脫位(developmental dislocation of hip,DDH)是一種兒童常見的髖部畸形,據(jù)國外最新報(bào)道新生兒DDH發(fā)病率約為4~11‰,未經(jīng)治療其髖部畸形會(huì)逐漸加重,導(dǎo)致疼痛、活動(dòng)受限、步態(tài)異常,嚴(yán)重影響患兒下肢活動(dòng)及功能,并早期出現(xiàn)退行性關(guān)節(jié)疾病。DDH一經(jīng)確診應(yīng)盡早干預(yù)治療,早期保守治療可以取得良好的臨床效果,但仍有一部分患兒因地域、家庭經(jīng)濟(jì)原因、家長的疏忽未能早期確診及治療,或經(jīng)保守治療失敗的DDH仍需手術(shù)治療。18個(gè)月后DDH患兒首選手術(shù)治療,經(jīng)過手術(shù)治療,大部分獲得了滿意的臨床效果,但有報(bào)道稱長期隨訪過程中,仍發(fā)現(xiàn)一部分患者出現(xiàn)了再脫位、發(fā)育不良、股骨頭壞死(AVN)、早期關(guān)節(jié)退行性變、骨性關(guān)節(jié)炎等。有學(xué)者對(duì)DDH手術(shù)前后進(jìn)行了三維步態(tài)分析,發(fā)現(xiàn)手術(shù)后所有患兒都出現(xiàn)骨盆降低并前傾不足,患側(cè)髖關(guān)節(jié)降低并屈曲活動(dòng)減少,可能與術(shù)后髖關(guān)節(jié)周圍軟組織攣縮,導(dǎo)致健側(cè)過度代償,股骨短縮旋轉(zhuǎn)截骨有關(guān)。也有學(xué)者通過步態(tài)分析中足底壓力測試發(fā)現(xiàn)切開復(fù)位Pemberton截骨手術(shù)(PPO)后的髖關(guān)節(jié)的負(fù)荷在行走過程中比正常兒童要大,可能是發(fā)生髖關(guān)節(jié)骨性關(guān)節(jié)炎的危險(xiǎn)因素,且發(fā)現(xiàn)足底不同分區(qū)的觸地面積、壓強(qiáng)也有異常,進(jìn)而研制出保護(hù)異常足底區(qū)域的矯正鞋,有效減輕了足痛和局部損傷。目前,髖關(guān)節(jié)切開復(fù)位salter骨盆截骨股骨去旋轉(zhuǎn)截骨術(shù)(SIO)是治療DDH主要的術(shù)式,但對(duì)其手術(shù)后步態(tài)分析,特別是足底壓力分布情況研究較少,本研究主要是評(píng)估DDH患兒手術(shù)后步態(tài)及足底壓力分布是否異常,以及異常的特點(diǎn)及程度,并與同年齡段正常兒童對(duì)比,從而分析原因,為評(píng)估手術(shù)效果和術(shù)后康復(fù)治療提供客觀依據(jù)。目的探討單側(cè)DDH患兒在SIO手術(shù)后的步態(tài)及足底壓力分布特點(diǎn),以及與同年齡段正常兒童的差異,為傳統(tǒng)方法評(píng)估手術(shù)效果提供有效補(bǔ)充,為下一步康復(fù)治療提供客觀的生物力學(xué)依據(jù)。方法1.實(shí)驗(yàn)組:選擇我院骨科病區(qū)2014年9月至2016年1月收治的經(jīng)SIO治療的單側(cè)DDH患兒25名;對(duì)照組:選取25名同年齡段的健康兒童作為對(duì)照。手術(shù)前后常規(guī)進(jìn)行體格檢查及影像學(xué)檢查,應(yīng)用Severin評(píng)分行影像學(xué)評(píng)估以及應(yīng)用Mckay評(píng)分行髖關(guān)節(jié)功能評(píng)估。2.通過footscan7足底壓力測試系統(tǒng)的測力平臺(tái),對(duì)實(shí)驗(yàn)組患兒進(jìn)行術(shù)后1年時(shí)的步態(tài)分析檢查,對(duì)實(shí)驗(yàn)組健康兒童進(jìn)行相同的檢查,記錄相關(guān)數(shù)據(jù)。在患肢與健肢,患肢與對(duì)照組,健肢與對(duì)照組之間的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,描述手術(shù)后患者步態(tài)及足底壓力的分布情況。結(jié)果1.病變組手術(shù)取得了良好的臨床效果。按照McKay功能評(píng)定標(biāo)準(zhǔn),術(shù)后優(yōu)良率96%;按Severin評(píng)分標(biāo)準(zhǔn)術(shù)后優(yōu)良率96%;髖臼指數(shù)(AI):術(shù)前(34.87±3.15)°,術(shù)后(22.32±1.89)°,差異有統(tǒng)計(jì)學(xué)意義(p0.05);中心邊緣角(CEA):術(shù)前(14.87±1.15)°,術(shù)后(30.02±3.89)°,差異有統(tǒng)計(jì)學(xué)意義(p0.05);股骨頸前傾角(FNA):術(shù)前(49.38±9.67)°,術(shù)后(21.32±3.11)°,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。2.SIO術(shù)后1年時(shí),步態(tài)分析檢查發(fā)現(xiàn)患兒平均步長為(30.15±4.97)cm,與對(duì)照組的平均步長相比有統(tǒng)計(jì)學(xué)差異(p0.05),小于對(duì)照組;在步寬、步速方面,與對(duì)照組相比無顯著統(tǒng)計(jì)學(xué)意義(p0.05)。3.SIO術(shù)后1年時(shí),患肢足底各分區(qū)荷載率與健肢相比,無顯著統(tǒng)計(jì)學(xué)差異(p值均0.05);患肢與對(duì)照組相比較,T1區(qū)存在顯著差異(p0.05),且由95%置信區(qū)間為[-0.082,-0.026],患肢T1區(qū)的負(fù)載率小于對(duì)照組;T2-5區(qū)也存在統(tǒng)計(jì)學(xué)差異(p0.05),且95%置信區(qū)間為[-0.067,-0.011],患肢T2-5區(qū)負(fù)載率也小于對(duì)照組。健肢T2-5、M2、LH區(qū)域的負(fù)載率與對(duì)照組相比有統(tǒng)計(jì)學(xué)差異(p0.05),且小于對(duì)照組。4.SIO術(shù)后1年時(shí),患肢足底各分區(qū)CA%與健肢相比,M2有統(tǒng)計(jì)學(xué)差異(p0.05),患肢M2的CA%小于健肢;患肢MH的CA%與健肢相比有統(tǒng)計(jì)學(xué)差異(p0.05),患肢MH的CA%大于健肢;余組相比較,無顯著統(tǒng)計(jì)學(xué)差異(p值均0.05)�；贾c對(duì)照組相比較,M1、M2、M5、LH、MH區(qū)均存在顯著差異(p值均0.05),M1、M2、LH、MH的CA%小于對(duì)照組,而M5的CA%大于于對(duì)照組;余區(qū)域相比較,無顯著統(tǒng)計(jì)學(xué)差異(p值均0.05)。健肢與對(duì)照組相比較,MH區(qū)均存在顯著差異(p0.05),MH的CA%小于對(duì)照組;余區(qū)域相比較,無顯著統(tǒng)計(jì)學(xué)差異(p值均0.05)。5.SIO術(shù)后1年時(shí),患肢足底各分區(qū)沖量與健肢相比,T2-5有統(tǒng)計(jì)學(xué)差異(p0.05),患肢T2-5的沖量小于健肢;患肢MF的沖量與健肢相比有統(tǒng)計(jì)學(xué)差異(p0.05),患肢MF的沖量小于健肢;余組相比較,無顯著統(tǒng)計(jì)學(xué)差異(p值均0.05)。患肢與對(duì)照組相比較,M2、M3均存在顯著差異(p值均0.05),M2、M3的沖量小于對(duì)照組;余區(qū)域相比較,無顯著統(tǒng)計(jì)學(xué)差異(p值均0.05)。健肢與對(duì)照組相比較,M2、LH均存在顯著統(tǒng)計(jì)學(xué)差異(p0.05),M2、LH的沖量小于對(duì)照組;余區(qū)域相比較,無顯著統(tǒng)計(jì)學(xué)差異(p值均0.05)。結(jié)論1.SIO術(shù)后在Severin影像學(xué)及McKay功能評(píng)分優(yōu)良率均有顯著提高,髖臼指數(shù)、前傾角均較術(shù)前顯著減小,中心邊緣角較術(shù)前顯著增大,歸于正常范圍,手術(shù)療效確切。2.SIO術(shù)后1年時(shí),步長仍小于正常,步寬、步速基本正常。3.SIO術(shù)后1年時(shí),患兒足底某些分區(qū)在荷載率、觸地面積、沖量等方面仍存在異常,可能與殘余畸形有關(guān)。
[Abstract]:Developmental dislocation of hip (DDH) is a common deformity of the hip in children. According to the latest reports, the incidence of DDH in newborn infants is approximately 4~11 per thousand, and the hip malformation will gradually aggravate without treatment, which leads to pain, limited activity and abnormal gait, which seriously affects the activity and function of the lower extremities, and early appears. The treatment of degenerative joint disease.DDH should be treated as early as possible. Early conservative treatment can achieve good clinical effect, but there are still some children because of the region, family economic reasons, parents' negligence failed early diagnosis and treatment, or the failure of conservative treatment of DDH still needs surgical treatment.18 months after the first choice of surgical treatment for children with DDH. Most of the patients received satisfactory clinical results, but some patients were reported to have redislocation, dysplasia, osteonecrosis of the femoral head (AVN), early degeneration of the joint, osteoarthritis, and so on. Some scholars conducted a three-dimensional gait analysis before and after the DDH operation and found all the children after the operation. The reduction of the pelvis and forward tilt, the reduction of the affected hip joint and the decrease of flexion, may be associated with the soft tissue contracture around the hip joint, resulting in excessive compensatory side of the healthy side, and the femoral shortening rotation osteotomy. Some scholars also found the load of the hip joint after the resection of the Pemberton osteotomy (PPO) through the foot stress test in the gait analysis. In the course of walking, larger than normal children may be a risk factor for the occurrence of osteoarthritis of the hip, and the area of the ground in different subareas of the foot is found and the pressure is abnormal, and the corrective shoes are developed to protect the abnormal foot area, which effectively alleviates the foot pain and local injury. At present, the hip joint is cut and repositioned by the Salter pelvis osteotomy femur. Rotational osteotomy (SIO) is the main operation for the treatment of DDH, but the analysis of the gait, especially the distribution of the foot pressure after operation, is less. This study is mainly to evaluate the abnormal distribution of the gait and the foot pressure in the children of DDH, and the abnormal characteristics and degree, and compare it with the normal children of the same age, and analyze the reasons. Objective to provide an objective basis for evaluating the effect of operation and postoperative rehabilitation. Objective to explore the distribution of the gait and the foot pressure of the unilateral DDH children after SIO operation, and the difference between the normal children of the same age group, and to provide an effective supplement to the traditional methods to evaluate the effect of the operation, and to provide an objective biomechanical basis for the next step of rehabilitation. 1. experimental group: selected 25 children of unilateral DDH treated by SIO from September 2014 to January 2016 in our hospital; control group: 25 healthy children of the same age group were selected as control. The routine examination and imaging examination before and after operation, the application of Severin score for image evaluation and the application of Mckay score for hip joint work .2. can be evaluated through the force platform of the footscan7 foot pressure test system to examine the gait analysis of the children in the experimental group 1 years after the operation. The same examination was carried out on the healthy children in the experimental group, and the related data were recorded. The data between the affected limbs and the limbs, the affected limbs and the control group, the health limb and the control group were statistically analyzed, and the operation after the operation was described. Results of the patients' gait and the distribution of foot pressure. Results the 1. lesion group had good clinical effect. According to the McKay function evaluation standard, the excellent rate was 96%, the excellent rate was 96% after the Severin score; the acetabular index (AI): before operation (34.87 + 3.15) and (22.32 + 1.89) degrees, the difference was statistically significant (P0.05); the center edge angle (CEA Preoperative (14.87 + 1.15) degrees, postoperative (30.02 + 3.89) degrees, the difference was statistically significant (P0.05), femoral neck obliquity (FNA): preoperative (49.38 + 9.67) degrees, postoperative (21.32 + 3.11) degrees, the difference was statistically significant (P0.05).2.SIO after 1 years, gait analysis found that the average step of children was (30.15 + 4.97) cm, compared with the average step of the control group. The study difference (P0.05) was less than that of the control group; there was no significant statistical significance in step width and step speed compared with the control group (P0.05) 1 years after.3.SIO, there was no significant statistical difference (P value, 0.05) compared with the healthy limbs at 1 years after the operation, and there was a significant difference between the affected limbs and the control group (P0.05), and the 95% confidence interval was [-0.. 082, -0.026], the load rate of T1 area in the affected limb was less than that of the control group, and there was also a statistical difference in the T2-5 area (P0.05), and the 95% confidence interval was [-0.067, -0.011], and the load rate of T2-5 zone in the affected limb was also smaller than that of the control group. The load rate of the limb T2-5, M2, LH area was statistically different from the control group (P0.05), and was less than that of the control group at 1 years after the.4.SIO operation. Compared with the healthy limb, M2 had statistical difference (P0.05), and the CA% of M2 in the affected limb was less than that of the healthy limb, and the CA% of the affected limb MH was significantly different from the healthy limb (P0.05), and the CA% of the limb MH was larger than the healthy limb; there was no significant difference between the remaining groups (P, all 0.05). The CA% of M2, LH and MH was less than that of the control group, and the CA% of M5 was greater than that of the control group. There was no significant difference in the residual region (P value was 0.05). Compared with the control group, there were significant differences in MH area (P0.05), MH CA% was smaller than the control group, and there was no significant difference between the remaining regions (P values were 0.05) at 1 years after the operation. Compared with the healthy limb, T2-5 had statistical difference (P0.05), and the impulse of T2-5 in the affected limb was less than that of the healthy limb; the impulse of MF in the affected limb was significantly different from that of the healthy limb (P0.05), and the impulse of the affected limb was less than that of the healthy limb; there was no significant difference (P value 0.05) in the remaining group (P value). There were significant differences in M2 and M3 (P value 0.05), M2 in the affected limbs compared with the control group. The impulse of M3 was less than that of the control group; there was no significant difference in the residual region (P value was 0.05). Compared with the control group, there were significant differences in M2 and LH (P0.05), M2, LH were less than the control group, and there was no significant difference in the residual region (P value, 0.05). Conclusion: Severin imaging and McKay function score after the operation of 1.SIO. The rate of good and good is significantly improved. The acetabular index and the pretilt angle are significantly lower than those before the operation, and the center edge angle is significantly increased in the normal range. The step length is still less than the normal and step width at 1 years after the operation, and the step speed is basically normal after the operation of.3.SIO. At the time of 1 years after the operation, the children's plantar areas are in the load rate, the area of touch ground, the impulse and so on. There is still abnormality in the surface, which may be related to the residual deformity.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.8

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