| BackgroundDevelopmental dysplasia of the hip(DDH)is one of the most common diseases in pediatric orthopedics.In China,the incidence of DDH is up to 5 ‰,and in foreign countries,it ranges from 2 to 50 ‰.The ratio of male to female is 1:4.75.The incidence of DDH is significantly different between races and regions,with the highest incidence in the white race and the second highest in the yellow race,which is related to genetic factors,environmental influences and living habits.DDH is caused by dysplasia of the proximal femur and acetabular anatomical structure,which is manifested as acetabular dysplasia,subluxation or dislocation,resulting in hip joint dysfunction.Its pathogenesis is unclear and the literature has shown that it is associated with gene mutations.Without treatment,the deformity of the hip will gradually worsen,resulting in pain,limited movement and abnormal gait,which will seriously affect the lower limb function of the child.DDH should be treated as soon as possible once diagnosed.Early conservative treatment can achieve good clinical results.However,some children still fail to receive early diagnosis and treatment due to geographical location,family economic reasons,and parental negligence,or need surgical treatment after failure of conservative treatment.There are many DDH treatment methods,and the selection of different treatment regiments at different ages and different types and the evaluation of efficacy are more complicated.It can be divided into closed reduction conservative treatment and open reduction surgical treatment.Open reduction surgery treatment is aimed at more than 18 months of children,most of the dislocation of the hip in children with although fully reset after surgery,but due to the existence of the patients of joint system dysplasia,joint and neuromuscular trauma caused by surgery and for a long period of time after a plaster cast,joints,brake,the influence of various factors such as scar contracture,children are often left hip joint stiffness,dysfunction and other sequelae,and even lead to abnormal activity of the knee and ankle,eventually led to the children,walking gait abnormalities.Gait analysis is an examination method for studying walking rules.It reveals the key links and influencing factors of gait abnormalities through biomechanics and kinematics,so as to guide the formulation of surgical plans and the evaluation of therapeutic effects.Some scholars conducted a three-dimensional gait analysis before and after DDH surgery,and found that the decreased pelvis and insufficient forward inclination,the decreased hip joint on the affected side and the decreased flexion activity after the surgery may be related to the postoperative contracture of the soft tissues around the hip joint,resulting in excessive compensation of the healthy side,and femoral shortening and rotation osteotomy.The continuous optimization and improvement of the treatment plan and efficacy evaluation system for developmental dislocation of the hip joint is one of the key and hot topics in the international and domestic pediatric orthopedic clinical and scientific research.This research mainly through the three-dimensional gait analysis system for acquisition of children with developmental dislocation of the hip that preoperative and postoperative gait parameters,compared with the normal age child,summarizes its gait characteristics,evaluation of DDH with abnormal gait whether after the surgery,and the characteristics and the degree of abnormal,provide objective basis for evaluating operation effect,in order to better promote the application of evidence-based medicine in orthopedic surgery in children.ObjectiveThrough three-dimensional gait analysis system for acquisition of children with developmental dislocation of the hip that preoperative and postoperative gait parameters,compared with the normal age child,summarizes its gait characteristics,evaluation of DDH with abnormal gait whether after the surgery,and the characteristics and the degree of abnormal,provide an effective supplement for the traditional methods to evaluate the effect of operation,provide objective basis for evaluating operation effect,in order to better promote the application of evidence-based medicine in orthopedic surgery in children.Methods1.Experimental group: 20 DDH children admitted to the orthopaedic ward of our hospital from January 2018 to January 2019 who met the inclusion criteria were selected.Control group:20 healthy children of the same age were selected as controls.Routine physical examination and imaging examination were performed before and after the operation.Severin was used to evaluate the imaging evaluation of the branch and Mckay was used to evaluate the hip joint function of the branch.2.British Vicon the three-dimensional motion capture system was used to analyze the gait of normal children and DDH children in the experimental group before,6 months after and 12 months after surgery,and relevant data were recorded.SPSS 20.0 software was used for statistical analysis of the data to describe the gait characteristics of the children before and after surgery.Results1.Comparison of general data between DDH children in the experimental group and normal children in the control group: there was no statistical difference in age,weight and height(p>0.05).2.There were 20 cases in the experimental group,20 cases were followed up 6 months after the operation,16 cases were followed up 12 months after the operation,and 4 cases were lost to follow-up,with a loss rate of 20%.3.Changes of the hip joint function before and after operation in children with DDH:according to the Mc Kay hip joint function evaluation standard,the excellent and good rate was95% 6 months after operation.The excellent and good rate was 94% 12 months after surgery.4.Imaging changes before and after surgery in children with DDH: according to the imaging Severin scoring standard,the excellent and good rate was 100% 6 months after surgery;12months after the operation,the excellent and good rate was 100%.The operation has achieved satisfactory clinical results with accurate curative effect.There is no postoperative dislocation,no AVN,and no obvious limitation of motion of the hip joint.5.Comparison of preoperative gait parameters between DDH children and normal children:preoperative step length of the affected side was(0.48±0.03)m,while that of normal children was(0.52±0.03)m,with statistically significant difference(p<0.05);Preoperative step width(13.35±0.96)cm and that of normal children(9.83±0.50)cm,the difference was statistically significant(p<0.05);Preoperative step frequency(105.00±3.95)steps/min,normal children(105.85±3.94)steps/min,the difference was not statistically significant(p>0.05);Preoperative gait speed(0.86±0.06)m/s and that of normal children(0.92±0.07)m/s,the difference was statistically significant(p<0.05);Before surgery,the deviation Angle of the affected lateral foot was 12.67±1.47 °,and that of the normal children was 8.06±0.85 °.The difference was statistically significant(p<0.05).6.Six months after surgery,DDH children were compared with those before surgery: step length increased,step width decreased,step speed increased,foot deviation Angle decreased,and step frequency did not change significantly(p>0.05);12 months after surgery,DDH children were compared with those before surgery: step length increased,step width decreased,step speed increased,foot deviation Angle decreased,and step frequency did not change significantly(p>0.05);12 months after DDH compared with 6 months after DDH: step length increased,step width decreased,foot Angle decreased,and step speed and step frequency did not change significantly(p>0.05).7.Six months after surgery,kinematic parameters of DDH were compared with those before surgery: hip flexure Angle: 6 months after surgery(17.15±1.17)°,and before surgery(15.96±1.18)°,with statistically significant difference(p<0.05);Hip joint straightening angle:6 months after surgery(4.98±0.47)°,preoperative(4.47±0.69)°,the difference was statistically significant(p<0.05);Hip range of motion: 6 months after surgery(22.12±1.34)°,and before surgery(20.43±1.45)°,the difference was statistically significant(p<0.05);Knee flexion Angle: 6 months after surgery(52.42±2.10)°,and before surgery(50.57±3.11)°,the difference was statistically significant(p<0.05);Ankle-joint dorsi-flexion Angle: 6 months after surgery(7.52±1.06)°,preoperative(6.41±1.20)°,the difference was statistically significant(p<0.05);Angle of plantar flexion of ankle joint: 6 months after surgery(14.04±1.44)°,and before surgery(11.75±1.26)°,the difference was statistically significant(p<0.05);Ankle range of motion: 6 months after surgery(21.56±1.87)°,and before surgery(18.16±2.01)°,the difference was statistically significant(p<0.05).8.The kinematics parameters of DDH in 12 months after operation were compared with those before operation: hip flexion Angle,extension Angle,hip range of motion,knee flexion Angle,ankle dorsi-flexion Angle,ankle plantar flexion Angle and ankle range of motion all increased compared with that before surgery,with statistically significant differences(p<0.05);12months after DDH compared with 6 months after DDH: hip flexion Angle,elongation Angle,hip range of motion,knee flexion Angle,ankle dorsiflexion Angle,ankle plantar flexion Angle and ankle range of motion all increased,with statistically significant differences(p<0.05).Conclusions1.DDH patients after surgery in Mc Kay function score and Severin imaging score was significantly improve,index of the acetabulum,femoral neck neck stem Angle and dip before preoperative significantly decreases,and center edge Angle back to normal range,curative effect is surgery and postoperative dislocation phenomenon,no AVN,did not see clearly constrained hip joint mobility.However,there was no significant improvement in the imaging index 12 months after surgery compared with 6 months after surgery.2.Preoperative comparison of DDH children with normal children: the step length decreased,the step width increased,the step speed decreased,and the foot Angle increased.6 months and 12 months after the operation compared with the operation: the step size increased,the step width decreased,the step speed increased,and the foot Angle decreased.These time-space parameters were all improved after the operation compared with the operation,and they were closer to the normal children,and the improvement was more obvious with the passage of time.3.Compared with the preoperative kinematics parameters 6 and 12 months after the operation of DDH children,the postoperative hip joint flexion Angle,extension Angle,hip joint mobility,knee flexion Angle,ankle joint dorsiflexion Angle,ankle joint plantar flexion Angle and ankle joint range of motion all increased compared with that before the operation,suggesting the improvement of all joint functions.And over time the function of each joint improved more obviously. |
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