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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 568 -575. doi: 10.3877/cma.j.issn.1674-134X.2022.05.007

基础论著

健康大学生平地步行时髋关节三维运动学特征研究
谢珍艳1, 曾小龙2, 黄文汉2, 钟国庆1, 陈浩斌2, 马立敏2, 肖进2, 张余2,†()   
  1. 1. 510080　广州，广东省人民医院（广东省医学科学院）骨科中心；515041　汕头大学医学院
    2. 510080　广州，广东省人民医院（广东省医学科学院）骨科中心
  • 收稿日期:2021-04-29 出版日期:2022-10-01
  • 通信作者: 张余
  • 基金资助:
    国家自然科学基金项目(81972126)

Study on three dimensional kinematic characteristics of hip joint in healthy college students

Zhenyan Xie1, Xiaolong Zeng2, Wenhan Huang2, Guoqing Zhong1, Haobin Chen2, Limin Ma2, Jin Xiao2, Yu Zhang2,†()   

  1. 1. Department of Orthopedics, Guangdong Provincial People’s Hospital Affiliated to South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Shantou University Medical College, Shantou 515041, China
    2. Department of Orthopedics, Guangdong Provincial People’s Hospital Affiliated to South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
  • Received:2021-04-29 Published:2022-10-01
  • Corresponding author: Yu Zhang
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引用本文：

谢珍艳, 曾小龙, 黄文汉, 钟国庆, 陈浩斌, 马立敏, 肖进, 张余. 健康大学生平地步行时髋关节三维运动学特征研究[J]. 中华关节外科杂志(电子版), 2022, 16(05): 568-575.

Zhenyan Xie, Xiaolong Zeng, Wenhan Huang, Guoqing Zhong, Haobin Chen, Limin Ma, Jin Xiao, Yu Zhang. Study on three dimensional kinematic characteristics of hip joint in healthy college students[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(05): 568-575.

目的

通过三维步态分析系统探究健康受试者髋关节内收/外展、内旋/外旋以及屈/伸三个角度自由度运动学步态特征，并进一步分析性别及是否优势腿间髋关节运动学参数的差异。

方法

本实验共招募了健康大学生受试者30名(15名男性，15名女性)作为研究对象，采用三维步态分析系统采集受试者髋关节在自选速度步行状态下的角度运动学数据，应用配对样本t检验对优势腿与非优势腿之间的髋关节在步态周期运动学数据及运动范围进行统计学分析，其余参数使用独立样本t检验进行分析。

结果

髋关节运动在步态周期呈现规律性改变。在内收/外展自由度中，优势腿和非优势腿在41%~64%步态周期(站立后期和摆动前期)差异有统计学意义[支撑相末期50%(t＝2.32，P＝0.028)]，运动范围差异也有统计学意义(t＝9.387，P < 0.05)，性别间差异无统计学意义(P<0.05)。在内/外旋自由度中，性别在步态周期大部分时相差异均有统计学意义[支撑相末期50%(t＝2.445，P＝0.018)，摆动相早期62%(t＝2.540，P＝0.014)]。运动范围的比较中是否为优势腿差异有统计学意义(t＝2.319，P＝0.028)，而性别间差异无统计学意义(P<0.05)。在屈/伸自由度中，性别在步态周期59%~86%间(包括摆动相前期、摆动相早期及摆动相中期)差异有统计学意义(摆动相早期62%：t＝－2.371，P＝0.021)；优势侧和非优势侧对比中，在步态周期1%~39%(脚跟着地期、负载期、站立中期、部分站立后期)和76%~100%(摆动相中期、摆动相末期)屈曲角度差异有统计学意义(支撑相中期31%：t＝3.024，P＝0.005，最大屈曲角度89%：t＝8.702，P<0.001)。运动范围的比较中是否为优势腿差异有统计学意义(t＝9.387，P<0.001)。

结论

本研究展现了健康受试者髋关节运动学在步态周期的规律性变化，可为髋关节疾病运动特征研究提供可参考的依据，且髋关节步态分析时应考虑性别和优势腿在髋关节运动的影响。

关键词: 髋关节, 性别因素, 功能偏侧化, 步态分析
Objective

To explore the three angle degrees of kinematic characteristics of hip joint in the gait cycle: adduction/abduction, internal/external and flexion/extension during gait of healthy subjects by three-dimensional gait analysis system, furthermore, the kinematic parameters of the hip joint between the dominant and dominant legs were analyzed.

Methods

Thirty healthy subjects (15 male and 15 female) were recruited as the research objects. The kinematic data of hip joint in walking state were collected by three-dimensional gait analysis system. Paired sample t test was used to statistically analyze the kinematics data and motion range of the hip joint between the dominant leg and the non-dominant leg in the gait cycle, and the other parameters were analyzed by independent sample t test.

Results

The hip joint movement showed regular changes in gait cycle. In the adduction/abduction degrees of freedom, the dominant leg and the non-dominant leg showed statistically significant difference in 41% to 64% of gait cycle (late standing and early swing), 50% in the late supporting phase (t=2.32, P=0.028), and the difference in the range of motion was also statistically significant (t=9.387, P< 0.05), but there was no statistically significant difference between sexes. In the internal/external rotational degrees of freedom, the gender differences in most phases of gait cycle were statistically significant, 50% in the late support phase (t=2.445, P= 0.018) and 62% in the early swing phase (t=2.540, P=0.014). In the comparison of the range of motion, the difference between the dominant legs was statistically significant (t=2.319, P=0.028), while the difference between the sexes was not statistically significant(P>0.05). In the flexion/extension degrees of freedom, the gender difference was statistically significant among 59%~86% of the gait cycle (including early swing phase, early swing phase and middle swing phase) ( 62% of the early swing phase: t=-2.371, P=0.021). In the comparison of dominant side and non-dominant side, there were significant differences in the flexion angle between 1%~39% (heel landing stage, load stage, middle standing stage, and late partial standing stage) and 76%~100% (middle swing phase, end swing phase) of gait cycle (31% in the middle support phase: t=3.024, P=0.005, the maximum flexion angle 89%: t=8.702, P<0.001). There was statistically significant difference between the dominant and non-dominant legs in the comparison of the range of motion (t=9.387, P<0.001)

Conclusions

The regular changes of hip joint kinematics in gait cycle of healthy subjects are showed in this study, which can provide reference for the research of hip joint disease motion characteristics. The impact of gender and dominant leg should be considered in hip gait analysis.

Key words: Hip joint, Sex factors, Functional laterality, Gait analysis
图1 运动数据采集过程中的骨性标记点定位示意图注：受试者髋关节坐标系建立时骨性标志点标定场景，操作者应用红外光导航探针识别患者骨性标志点，由系统自动识别建立髋关节运动坐标系
图2 髋关节运动坐标体系的建立注：系统在依靠骨性标记点与markers之间的关系建立髋关节运动坐标体系，髋关节股骨头中心围绕着坐标轴可进行屈/伸、内/外旋以及内收/外展运动
表1 受试者人口学特征参数分布情况(±s)
变量 例数 年龄(岁) 身高(cm) 体重(kg) 身体质量指数(kg/m2)
总体 30 20.5±1.2 169.6±5.6 58.5±7.5 20.3±1.2
男性 15 20.5±1.3 171.1±6.7 60.7±7.9 20.7±2.4
女性 15 20.5±1.1 168.1±4.8 56.3±6.5 19.9±2.0
t值   <0.001 2.141 2.371 1.436
P值   >0.05 0.036 0.021 >0.05
图3 髋关节内收/外展自由度在步态周期的变化。图A为步态周期中性别间内收外展角度的比较，图B为步态周期中左右侧间内收外展角度的比较注：图B中*表示在41%~64%步态周期中左右侧腿在内/外翻自由度中差异有统计学意义(50%步态周期：t＝2.32，P＝0.028)
图4 髋关节内/外旋自由度在步态周期的变化。图A为步态周期中性别间内外旋角度的比较，图B为步态周期中左右侧间内外旋角度的比较注：图A*表示在1%~64%、72%~84%、95%~100%步态周期中性别在内/外旋自由度差异有统计学意义(50%步态周期：t＝2.445，P＝0.018；62%步态周期：t＝2.540，P＝0.014)
图5 髋关节屈/伸自由度在步态周期的变化。图A为步态周期中性别间屈伸角度的比较，图B为步态周期中左右侧间屈伸角度的比较注：图A中*表示在59%~86%步态周期中性别在屈曲/伸展自由度差异有统计学意义(步态周期62%：t＝－2.371，P＝0.021)；图B中*表示1%~39%、76%~100%步态周期中左右侧腿在屈曲/伸展自由度差异有统计学意义(31%步态周期：t＝3.024，P＝0.005；89%步态周期：t＝8.702，P<0.001))
表2 受试者不同侧别髋关节3自由度运动范围对比[°，(±s)]
侧别 例数 内收/外展 内旋/外旋 屈曲/伸展
左侧髋关节 30 12.9±2.6 13.8±2.8 38.6±3.1
右侧髋关节 30 11.9±2.7 12.6±2.9 33.5±3.3
t值   3.156 2.319 9.387
P值   0.004 0.028 <0.001
表3 男女受试者的髋关节3自由度运动范围对比[°，(±s)]
性别 髋数 内收/外展 内旋/外旋 屈曲/伸展
男性 30 12.6±2.8 12.8±2.6 35.8±4.0
女性 30 12.3±2.6 12.5±3.3 36.3±4.1
t值   0.465 0.345 －0.518
P值   >0.05 >0.05 >0.05
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