髖關(guān)節(jié)疾病引起骨盆傾斜的原因分析
發(fā)布時間：2018-09-04 14:41
【摘要】：目的：通過分析髖關(guān)節(jié)疾病引起冠狀面骨盆傾斜(pelvic tilt, PT)的原因和臨床特點,研究其發(fā)生的規(guī)律性,探討符合此類疾病特征的骨盆傾斜的分類方法。方法：回顧性分析昆明醫(yī)科大學第一附屬醫(yī)院骨科2012年1月至2014年12月單側(cè)髖關(guān)節(jié)疾病引起冠狀面骨盆傾斜的180例患者,包括非創(chuàng)傷性股骨頭壞死(non-traumatic osteonecrosis of femoral head, NOTONFH)99例、髖關(guān)節(jié)原發(fā)性骨性關(guān)節(jié)炎(primary osteoarthritis of hip-joint, POAH)32例、發(fā)育性髖關(guān)節(jié)發(fā)育不良(developmental dysplasia of hip-joint, DDH)22例、類風濕性髖關(guān)節(jié)炎(rheumatoid arthritis of hip-Joint, RAH)17例、感染性髖關(guān)節(jié)炎(infectious hip osteoarthritis, IHOA)10例,對患者進行一般情況、全身情況、髖關(guān)節(jié)局部情況及影像學資料等的綜合評估。通過采集病史,追溯病情進展、演變情況,了解發(fā)病緩急、臨床表現(xiàn)及生活質(zhì)量；詳細評價髖關(guān)節(jié)的外觀情況、畸形特征、WHO疼痛分級及關(guān)節(jié)活動度,以此評估髖關(guān)節(jié)功能,明確患側(cè)髖關(guān)節(jié)功能改變的類型與機理；通過檢測骨盆傾斜的方向、度數(shù)及雙側(cè)棘踩線、臍踝線的長度,明確骨盆傾斜及患肢短縮的程度,并結(jié)合患側(cè)髖關(guān)節(jié)功能改變后的畸形類型,分析發(fā)生冠狀面骨盆傾斜的原因,研究其規(guī)律性、探討符合此類疾病特征的骨盆傾斜的分類方法。結(jié)果：1 180例髖關(guān)節(jié)疾病引起骨盆傾斜的臨床特點：(1)骨盆向患側(cè)肢體傾斜,稱之為Ⅰ型骨盆傾斜,共37例�；紓�(cè)髖關(guān)節(jié)不同程度的屈曲、外展攣縮畸形,患肢可持重、行走,行走時患側(cè)髖關(guān)節(jié)屈曲、外展,對側(cè)肢體內(nèi)收,骨盆向患側(cè)肢體傾斜。病程進展緩慢,髖關(guān)節(jié)疼痛較輕,以進行性加重的關(guān)節(jié)活動功能障礙為主要臨床表現(xiàn)。(2)骨盆向?qū)?cè)肢體傾斜,稱之為Ⅱ型骨盆傾斜,共143例。患側(cè)髖關(guān)節(jié)不同程度的屈曲、內(nèi)收攣縮畸形,患肢持重、行走功能較差,行走時患側(cè)髖關(guān)節(jié)屈曲、內(nèi)收,對側(cè)肢體外展,骨盆向?qū)?cè)肢體傾斜。病程進展較快,發(fā)病時及病程中以髖關(guān)節(jié)疼痛為主要臨床表現(xiàn)。2采用SPSS20.0軟件,對不同病因、不同髖關(guān)節(jié)疼痛分級的骨盆傾斜類型構(gòu)成比的差異進行x2檢驗,當條件不滿足時采用fisher精確檢驗。結(jié)果發(fā)現(xiàn)：(1)不同病因的骨盆傾斜類型構(gòu)成比有顯著性差異(fisher精確值=40.267,p0.05),即不同病因與骨盆傾斜類型有相關(guān)性,并發(fā)現(xiàn)非創(chuàng)傷性股骨頭壞死、髖關(guān)節(jié)原發(fā)性骨性關(guān)節(jié)炎、類風濕性髖關(guān)節(jié)炎和感染性髖關(guān)節(jié)炎傾向于發(fā)生Ⅱ型骨盆傾斜；(2)不同疼痛分級的骨盆傾斜類型構(gòu)成比存在顯著性差異(fisher精確值=96.739,p0.05),即疼痛分級與骨盆傾斜類型有相關(guān)性,并發(fā)現(xiàn)疼痛分級越高,Ⅱ型骨盆傾斜的比例越高,即傾向于發(fā)生Ⅱ型骨盆傾斜。結(jié)論：1如髖關(guān)節(jié)疾病病程中疼痛較輕,關(guān)節(jié)活動功能障礙進行性加重,患側(cè)髖關(guān)節(jié)多發(fā)生屈曲、外展攣縮畸形,骨盆向患側(cè)肢體傾斜；如疼痛較重,髖關(guān)節(jié)多發(fā)生屈曲、內(nèi)收攣縮畸形,骨盆向?qū)?cè)肢體傾斜。2單側(cè)髖關(guān)節(jié)疾病引起冠狀面骨盆傾斜的方向始終與軀體重心的移向一致,即均向外展側(cè)肢體傾斜；患肢短縮并不能決定骨盆傾斜的方向。3根據(jù)患側(cè)髖關(guān)節(jié)攣縮畸形的類型及患肢是否短縮,將骨盆傾斜分類如下：Ⅰ型：患側(cè)髖關(guān)節(jié)外展攣縮型ⅠA型：雙側(cè)棘踝線等長ⅠB型：雙側(cè)棘踝線不等長Ⅱ型：患側(cè)髖關(guān)節(jié)內(nèi)收攣縮型ⅡA型：雙側(cè)棘踝線等長ⅡB型：雙側(cè)棘踝線不等長4單側(cè)髖關(guān)節(jié)疾病引起的冠狀面骨盆傾斜,多為Ⅱ型骨盆傾斜。
[Abstract]:Objective: To analyze the causes and clinical features of coronal pelvic tilt (PT) caused by hip joint diseases, to study the regularity of PT and to explore the classification methods of PT. 180 cases of coronal pelvic obliquity caused by arthropathy included 99 cases of non-traumatic osteonecrosis of femoral head (NOTONFH), 32 cases of primary osteoarthritis of hip-joint (POAH), 32 cases of developmental dysplasia of hip-joint (DDH). 22 cases, 17 cases of rheumatoid arthritis of hip-Joint (RAH) and 10 cases of infectious hip osteoarthritis (IHOA) were assessed comprehensively by collecting the history of the disease, tracing the progress of the disease, understanding the evolution of the disease, and understanding the general situation, general condition, local situation of the hip joint and imaging data. Acute onset, clinical manifestations and quality of life; detailed evaluation of hip appearance, deformity characteristics, WHO pain classification and joint mobility, to assess hip function, to determine the type and mechanism of functional changes in the affected side of the hip; pelvic tilt direction, degree and bilateral spine line, umbilical and ankle line length, to determine the pelvic function. The causes of coronal pelvic obliquity were analyzed and the regularity of coronal pelvic obliquity was studied. The classification methods of coronal pelvic obliquity were discussed. Results: The clinical features of 1 180 cases of pelvic obliquity caused by hip joint diseases were as follows: (1) Pelvic obliquity to affected side limb. Body tilt, known as type I pelvic tilt, was found in 37 cases. Hip flexion, abduction contracture deformity, weight bearing, walking, hip flexion, abduction, contralateral extremity adduction, pelvic tilt to the affected side. The course of the disease progressed slowly and the pain of the hip joint was mild to progressively aggravate the joint dysfunction. (2) Pelvic tilt to the contralateral limbs, known as type II pelvic tilt, a total of 143 cases. Hip flexion, adduction contracture deformity, weight bearing, walking function is poor, walking hip flexion, adduction, contralateral extremity abduction, pelvic tilt to the contralateral limbs. The main clinical manifestation was hip pain during the course of treatment. 2 The composition of pelvic tilt type was tested by x2 test with SPSS20.0 software. The results showed that: (1) There were significant differences in the composition of pelvic tilt type among different causes and different grades of hip pain. The exact value was 40.267, p0.05, that is, different etiologies were associated with pelvic tilt type, and non-traumatic necrosis of femoral head, primary osteoarthritis of hip joint, rheumatoid hip arthritis and infectious hip arthritis tended to occur type II pelvic tilt; (2) there was a significant difference in the composition ratio of pelvic tilt type among different pain grades (f) Isher accurate value = 96.739, p0.05), that is, the pain classification and pelvic tilt type is related, and found that the higher the pain classification, the higher the proportion of type II pelvic tilt, that is inclined to type II pelvic tilt. Abduction contracture deformity, pelvic tilt to the affected side of the limb; if more pain, hip flexion, adduction contracture deformity, pelvic tilt to the opposite side of the limb. Direction of tilt: 3. Pelvic tilt was classified according to the type of contracture deformity of the affected hip and whether the affected limb was shortened or not. Type I: Hip abduction contracture type I A: Isometric length of bilateral spine-ankle line I B: Isometric length of bilateral spine-ankle line II: Invariant length of bilateral spine-ankle line II A: Isometric length of bilateral spine-ankle line II B: Isometric length of bilateral spine-ankle line II The lateral pelvis malleolus unequal length 4 is a unilateral hip joint disease caused by coronary pelvic tilt, most of which is type II pelvic obliquity.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4
本文編號：2222459
[Abstract]:Objective: To analyze the causes and clinical features of coronal pelvic tilt (PT) caused by hip joint diseases, to study the regularity of PT and to explore the classification methods of PT. 180 cases of coronal pelvic obliquity caused by arthropathy included 99 cases of non-traumatic osteonecrosis of femoral head (NOTONFH), 32 cases of primary osteoarthritis of hip-joint (POAH), 32 cases of developmental dysplasia of hip-joint (DDH). 22 cases, 17 cases of rheumatoid arthritis of hip-Joint (RAH) and 10 cases of infectious hip osteoarthritis (IHOA) were assessed comprehensively by collecting the history of the disease, tracing the progress of the disease, understanding the evolution of the disease, and understanding the general situation, general condition, local situation of the hip joint and imaging data. Acute onset, clinical manifestations and quality of life; detailed evaluation of hip appearance, deformity characteristics, WHO pain classification and joint mobility, to assess hip function, to determine the type and mechanism of functional changes in the affected side of the hip; pelvic tilt direction, degree and bilateral spine line, umbilical and ankle line length, to determine the pelvic function. The causes of coronal pelvic obliquity were analyzed and the regularity of coronal pelvic obliquity was studied. The classification methods of coronal pelvic obliquity were discussed. Results: The clinical features of 1 180 cases of pelvic obliquity caused by hip joint diseases were as follows: (1) Pelvic obliquity to affected side limb. Body tilt, known as type I pelvic tilt, was found in 37 cases. Hip flexion, abduction contracture deformity, weight bearing, walking, hip flexion, abduction, contralateral extremity adduction, pelvic tilt to the affected side. The course of the disease progressed slowly and the pain of the hip joint was mild to progressively aggravate the joint dysfunction. (2) Pelvic tilt to the contralateral limbs, known as type II pelvic tilt, a total of 143 cases. Hip flexion, adduction contracture deformity, weight bearing, walking function is poor, walking hip flexion, adduction, contralateral extremity abduction, pelvic tilt to the contralateral limbs. The main clinical manifestation was hip pain during the course of treatment. 2 The composition of pelvic tilt type was tested by x2 test with SPSS20.0 software. The results showed that: (1) There were significant differences in the composition of pelvic tilt type among different causes and different grades of hip pain. The exact value was 40.267, p0.05, that is, different etiologies were associated with pelvic tilt type, and non-traumatic necrosis of femoral head, primary osteoarthritis of hip joint, rheumatoid hip arthritis and infectious hip arthritis tended to occur type II pelvic tilt; (2) there was a significant difference in the composition ratio of pelvic tilt type among different pain grades (f) Isher accurate value = 96.739, p0.05), that is, the pain classification and pelvic tilt type is related, and found that the higher the pain classification, the higher the proportion of type II pelvic tilt, that is inclined to type II pelvic tilt. Abduction contracture deformity, pelvic tilt to the affected side of the limb; if more pain, hip flexion, adduction contracture deformity, pelvic tilt to the opposite side of the limb. Direction of tilt: 3. Pelvic tilt was classified according to the type of contracture deformity of the affected hip and whether the affected limb was shortened or not. Type I: Hip abduction contracture type I A: Isometric length of bilateral spine-ankle line I B: Isometric length of bilateral spine-ankle line II: Invariant length of bilateral spine-ankle line II A: Isometric length of bilateral spine-ankle line II B: Isometric length of bilateral spine-ankle line II The lateral pelvis malleolus unequal length 4 is a unilateral hip joint disease caused by coronary pelvic tilt, most of which is type II pelvic obliquity.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4
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