背景:Trendelenburg步态描述了单腿站立(SLS)期间对侧骨盆下垂,偶尔在站立肢体上进行侧躯干倾斜补偿。然而,在通常使用这种步态模式的人群中,对“未补偿的Trendelenburg”步态(独立于侧干倾斜的骨盆下降)的定量研究仍然很少,如青少年髋关节病理患者。
目的:在各种青少年髋部病变中,无补偿的特伦德伦伯格有多普遍,以及它与髋部负荷有什么关系,髋部外展力量,和自我报告的髋部疼痛?
方法:步态,力量,和疼痛数据收集152名临床诊断为髋臼髋关节发育不良的术前患者,股骨髋臼撞击,Legg-Calvé-Perthes,或滑脱股骨骨phy(SCFE)。SLS中动态骨盆下降≥5.4°的患者被分为“骨盆下降”组,并进行筛选以排除同侧躯干过度瘦的患者。然后使用Mann-Whitney测试将他们与“稳定的骨盆”患者进行比较。
结果:发育不良患者占盆腔滴组的比例最高(46%)。骨盆滴组显示自我报告的髋部疼痛显着增加(p=0.011),最大髋关节外展力矩(p=0.002),在SLS负荷响应期间,受影响髋部的冠状功率吸收峰值,(p<0.001),同时显示外展强度没有差异(p=0.381)。
结论:未补偿的Trendelenburg步态可能导致青少年髋关节病理患者受影响的髋关节负荷增加。不利的髋关节生物力学可以在这些病理人群中增加外展肌需求,发育不良患者的患病率最高。最大外展强度与骨盆跌落无关。未来的工作应旨在确定和量化因果因素。接受体重期间冠状髋关节功率吸收的增加值得临床关注,因为可能是有害的,在已经易患髋关节骨关节炎的人群中,过度依赖被动髋关节结构来支撑负荷。
Trendelenburg gait describes contralateral pelvic drop during single leg stance (SLS) with occasional lateral trunk lean compensation over the stance limb. However, quantitative research on \'uncompensated Trendelenburg\' gait (pelvic drop independent of lateral trunk lean) remains sparse among populations that commonly utilize this gait pattern, such as adolescent hip pathology patients.
How prevalent is uncompensated Trendelenburg among various adolescent hip pathologies and how is it related to hip load, hip abduction strength, and self-reported hip pain?
Gait, strength, and pain data were collected among 152 pre-operative patients clinically diagnosed with acetabular hip dysplasia, femoroacetabular impingement, Legg-Calvé-Perthes, or slipped capital femoral epiphysis (SCFE). Patients with ≥ 5.4° of dynamic pelvic drop in SLS were divided into a \'pelvic drop\' group and screened to exclude those with excessive ipsilateral trunk lean. They were then compared to the \'stable pelvis\' patients using a Mann-Whitney test.
Dysplasia patients represented the highest proportion of the pelvic drop group (46%). The pelvic drop group showed a significant increase in self-reported hip pain (p = 0.011), maximum hip abductor moment (p = 0.002), and peak coronal power absorption at the affected hip during SLS loading response, (p < 0.001) while showing no difference in abduction strength (p = 0.381).
Uncompensated Trendelenburg gait may lead to increased loading of the affected hip in adolescent hip pathology patients. Disadvantageous hip biomechanics can create increased abductor muscle demand among these pathological populations, with dysplasia patients showing the highest prevalence. Maximal abduction strength did not correlate with pelvic drop. Future work should aim to identify and quantify causal factors. Increased coronal hip power absorption during weight acceptance warrants clinical attention, as there may be a detrimental, over-reliance on passive hip structures to support load among a population that that is already predisposed to hip osteoarthritis.