| BackgroundDevelopmental dislocation of the hip(DDH)is a kind of common deformity in children.According to a latest report in foreign,the incidence of DDH of the newborn is about 4~11‰.Without treatment,the deformity of the hip will increase gradually,leading to pain,restricted movement,abnormal gait and serious influence on children’s activity and function,even early degenerative joint disease.Once a diagnosis of DDH is confirmed,the treatment should begin immediately,because a better effect can be getted by early conservative treatment.But,some of the children have to undergo surgery for losing chance or failure of early diagnosis and early treatment of DDH.Whatever the region,famly,economy or the thoughtless of their parents! Although most of children with DDH had underwent surgery,also obtained satisfactory clinical effect,but some reports still be setted,after the process of long-term follow-up,about that part of the patients appeared to dislocation,dysplasia,avascular necrosis(AVN),early joint degeneration and osteoarthritis.Some scholars studied with DDH,before and after surgery,by three-dimensional gait analysis and found that,after the operation,all patients were in lower pelvis and leaning forward,with the hip reduce and buckling activities,which may be related to postoperative soft tissue contracture around hip joint,causing the contralateral overcompensation,femoral shortening rotation cut bone.Through the gait analysis of plantar pressure test,Some orther scholars found that open reduction by Pemberton’s osteotomy(PPO)of hip lead that load in the hip is bigger than normal children,which may be risk factors for hip osteoarthritis.They also found the pressure of different partition area of a foot touched the ground also has the exception,and then developed the protection exception thenar area corrective shoes,effectively alleviate aching feet and partial damage.Salter’s osteotomy of pelvic and osteotomy of femur with rotary(SIO)is the popular surgery for treatment of DDH,but the gait analysis before and after operation,especially the plantar pressure distribution study is less,evaluate the gait and plantar pressure distribution is abnormal,and the characteristics and the degree of abnormal,so as to analyze the reason,to evaluate the operation effect and solutions to improve and provides an objective basis for postoperative rehabilitation has a positive meaning.ObjectiveThe objective of this study is to explore gait and plantar pressure changes of the children with DDH before and after operation which including open reduction,salter innominate osteotomy and osteotomy of femur with rotary.Compared with normal children and find the difference between them,providing effective supplement for traditional methods to evaluate the operation effect and improving the surgery and rehabilitation by providing objective biomechanical basis.Methods1.The experimental group: select 25(female 23,male 2)children with DDH,average age(30±2.39)months,in orthopedic ward of our hospital between September 2014 and January 2016,who treated by open reduction,salter innominate osteotomy and osteotomy of femur with rotary,when follow-up is about(20±9.54)months;Control group: select 25 healthy children at the same age of a kindergarten in zhengzhou as control.The condition of elected in : there is no history of surgery and trauma,no lower limb deformity and pain,joint and bone lesions,no nervous system abnormalities.Regular physical examination and imaging examination before and after operation,Severin evaluation branch imaging evaluation and application Mckay branches of the hip joint function assessment.2.Respectively before the operation and one year after surgery,undergo gait analysis in the laboratory through the footscan plantar pressure test system and record data,comparing in the limb and the healthy limbs,preoperative and postoperative in limb between control group and statistical analysis,evaluation of surgical effects on patient’s gait and plantar pressure changes.Results1.According to the McKay function evaluation standard,superior was 96%;Postoperative optimal by severin grading standard was 96%;AI: preoperative(34.87±3.15)°,AI(22.32±1.89)° after treatment,the difference was statistically significant(p<0.05).The CEA: preoperative(14.87±1.15)°,(30.02±3.89)° after treatment,the difference was statistically significant(p<0.05).FNA: preoperative(49.38±9.67)°,(21.32±3.11)° after treatment,the difference was statistically significant(p<0.05).2.One year after the surgery,gait analysis in check,found that average step length was 30.15±4.97,and with a control group of average step length was statistically difference(p<0.05),and less than the control group;Steps in width,speed,compared with the control group had no significant statistical significance(p > 0.05).3.The SIO postoperative limb’s plantar each partition load rate compared with the healthy limb,there was no statistically significant difference(p>0.05);Limb compared with control group,the T1 area exists significant difference(p<0.05),and the 95% confidence interal [-0.082,-0.026],it is concluded that limb T1 area load rate is less than the control group;T2-5 area there are statistically significant(p<0.05),and 95% confidence interal [-0.067,-0.011],it is concluded that limb T2-5 load rate is less than the control group.By the same token,the health limb T2-5,M2,LH area compared with the control group was statistically difference between the load rate,and less than the control group.4.The SIO postoperative thenar area in limb compared with the healthy limb CA %,M2 statistically significant(p<0.05),and limb’s M2 CA % less than the healthy limb;Limb’s CA % of MH compared with the healthy limb was statistically difference(p<0.05),and CA % of MH is greater than the healthy limb;Compared with other group,there was no statistically significant difference(p>0.05).Limb compared with control group,M1,M2,M5,LH,MH area there were significant differences(p< 0.05),and M1,M2,LH,MH CA % less than the control group,while the M5 CA % is greater than in the control group;other region,there was no statistically significant difference(p>0.05).Healthy limb compared with control group,MH area there are significant differences(p=0.048),and MH CA % less than the control group;other regions,there was no statistically significant difference(p>0.05).5.The SIO postoperative limb plantar each partition impulse,compared with the healthy limb T2-5 statistically significant(p<0.05),and the impulse of phantom T2-5 less than the healthy limb;Limb of MF impulse difference compared with the healthy limb(p<0.05),and the impulse of phantom MF is less than the healthy limb;Compared with the other group,there was no statistically significant difference(p> 0.05).Limb compared with control group,M2,M3,there were significant differences(p<0.05),and the impulse of M2,M3,less than the control group;other region,there was no statistically significant difference(p>0.05).The healthy limb compared with control group,the M2,LH there were statistically significant differences(p<0.05),and M2,LH pulse is less than the control group;other regions,there was no statistically significant difference(p>0.05).ConclusionsBy study gait and plantar pressure of childen with DDH,aged from 1.5~6 years old,before and after the SIO surgery has the following findings:1.Severin imaging and McKay function evaluation were significantly improved after the SIO operation,with index of the acetabulum,former Angle were compared with preoperative significant decreases,and center edge Angle increase significantly compared with preoperative,back to the normal range,having the precise surgery clinical effect.2.One year after surgery of SIO,step length is still less than normal,the step width and velocity are normal.3.One year after surgery of SIO,some partition of feet pelma in the load rate,contact area and impulse is still abnormal,which may be associated with residual deformity. |
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