人工股関節全置換術後早期における歩行時の自覚的脚長差に関連する因子
【目的】静止立位時よりも歩行時の自覚的脚長差（以下，PLLD）が延長する人工股関節全置換術（以下，THA）例の特徴を調査し，歩行時のPLLDに関連する因子を明らかにすることを目的とする。【方法】初回THAを行った91例を対象とし，術前および術後3週のX線パラメータ，PLLD（静止立位時・歩行時），関節可動域を調査した。【結果】静止立位時よりも歩行時のPLLDが延長する症例（n=13）は静止立位時と歩行時でPLLDが一致する症例（n=74）に比較して，有意に術側股関節の内転可動域，伸展可動域が不良であった。歩行時のPLLDを従属変数，調査項目を独立変数とした重回帰分析の結果，歩行時のPLLDに関...
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| Published in | 運動器理学療法学 Vol. 4; no. 1; pp. 10 - 18 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本運動器理学療法学会
2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2436-8075 |
| DOI | 10.57281/jofmpt.202321 |
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| Abstract | 【目的】静止立位時よりも歩行時の自覚的脚長差（以下，PLLD）が延長する人工股関節全置換術（以下，THA）例の特徴を調査し，歩行時のPLLDに関連する因子を明らかにすることを目的とする。【方法】初回THAを行った91例を対象とし，術前および術後3週のX線パラメータ，PLLD（静止立位時・歩行時），関節可動域を調査した。【結果】静止立位時よりも歩行時のPLLDが延長する症例（n=13）は静止立位時と歩行時でPLLDが一致する症例（n=74）に比較して，有意に術側股関節の内転可動域，伸展可動域が不良であった。歩行時のPLLDを従属変数，調査項目を独立変数とした重回帰分析の結果，歩行時のPLLDに関連する因子として術前および術後の構造的脚長差，術後骨盤側方傾斜角，術前骨盤腔縦径，術側股関節の内転可動域，伸展可動域が抽出された。【結論】歩行時のPLLDには術側股関節内転可動域，術後骨盤側方傾斜に加えて術側股関節伸展可動域が関連することが明らかとなった。 |
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| AbstractList | 【目的】静止立位時よりも歩行時の自覚的脚長差（以下，PLLD）が延長する人工股関節全置換術（以下，THA）例の特徴を調査し，歩行時のPLLDに関連する因子を明らかにすることを目的とする。【方法】初回THAを行った91例を対象とし，術前および術後3週のX線パラメータ，PLLD（静止立位時・歩行時），関節可動域を調査した。【結果】静止立位時よりも歩行時のPLLDが延長する症例（n=13）は静止立位時と歩行時でPLLDが一致する症例（n=74）に比較して，有意に術側股関節の内転可動域，伸展可動域が不良であった。歩行時のPLLDを従属変数，調査項目を独立変数とした重回帰分析の結果，歩行時のPLLDに関連する因子として術前および術後の構造的脚長差，術後骨盤側方傾斜角，術前骨盤腔縦径，術側股関節の内転可動域，伸展可動域が抽出された。【結論】歩行時のPLLDには術側股関節内転可動域，術後骨盤側方傾斜に加えて術側股関節伸展可動域が関連することが明らかとなった。 |
| Author | 菊谷, 優紀子 山下, 奈津美 平田, 健司 川端, 悠士 木村, 光浩 |
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| References | 21) Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174. 18) Ieiri A, Tushima E, Ishida K, et al.: Reliability of measurements of hip abduction strength obtained with a hand-held dynamometer. Physiother Theory Pract 2015; 31: 146–152. 26) Omichi Y, Goto T, Wada K, et al.: Impact of the hip-spine relationship and patient-perceived leg length discrepancy after total hip arthroplasty: A retrospective study. J Orthop Sci 2023: S0949-2658(23)00088-X. doi: 10.1016/j.jos.2023.03.018. 9) Takemoto G, Osawa Y, Seki T, et al.: A large preoperative pelvic oblique angle affects perception of leg length discrepancy after total hip arthroplasty. J Orthop Sci 2023. doi: 10.1016/j.jos.2023.01.013. 5) Nakanowatari T, Suzukamo Y, Suga T, et al.: True or apparent leg length discrepancy: which is a better predictor of short-term functional outcomes after total hip arthroplasty? J Geriatr Phys Ther 2013; 36: 169–174. 10) Kinoshita K, Kimura K, Miyamoto S, et al.: Relationship between perceived leg length discrepancy at one month and preoperative hip abductor muscle elasticity in patients after total hip arthroplasty. Phys Ther Res 2021; 24: 232–239. 16) Kitajima M, Mawatari M, Aita K, et al.: A simple method to determine the pelvic inclination angle based on anteroposterior radiographs. J Orthop Sci 2006; 11: 342–346. 15) Moharrami A, Mirghaderi P, Hoseini Zare N, et al.: Slight pelvic obliquity is normal in a healthy population: a cross-sectional study. J Exp Orthop 2023; 10: 57. 29) Sabharwal S, Kumar A: Methods for assessing leg length discrepancy. Clin Orthop Relat Res 2008; 466: 2910–2922. 19) O’Brien RM: A caution regarding rules of thumb for variance inflation factors. Quality and Quantity 2007; 41: 673–690. 11) 川端悠士，後藤圭太，武市理史，他：人工股関節全置換術例における自覚的脚長差に影響を与える要因 階層的重回帰分析を用いた検討．理学療法学 2015; 42: 408–415. 12) Koga D, Jinno T, Okawa A, et al.: The effect of preoperative lateral flexibility of the lumbar spine on perceived leg length discrepancy after total hip arthroplasty. J Med Dent Sci 2009; 56: 69–77. 3) Waibel FWA, Berndt K, Jentzsch T, et al.: Symptomatic leg length discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res 2021; 107: 102761. 13) Harris I, Hatfield A, Walton J: Assessing leg length discrepancy after femoral fracture: clinical examination or computed tomography? ANZ J Surg 2005; 75: 319–321. 1) Faldini C: Leg length discrepancy after primary total hip replacement. Musculoskelet Surg 2023; 107: 1–5. 6) Mahmood SS, Mukka SS, Crnalic S, et al.: The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty 2015; 30: 1638–1642. 25) Tateuchi H, Tsukagoshi R, Fukumoto Y, et al.: Dynamic hip joint stiffness in individuals with total hip arthroplasty: relationships between hip impairments and dynamics of the other joints. Clin Biomech (Bristol, Avon) 2011; 26: 598–604. 2) Iwakiri K, Ohta Y, Fujii T, et al.: Changes in patient-perceived leg length discrepancy following total hip arthroplasty. Eur J Orthop Surg Traumatol 2021; 31: 1355–1361. 20) Kozak M, Azevedo RA: Does using stepwise variable selection to build sequential path analysis models make sense? Physiol Plant 2011; 141: 197–200. 23) Bahl JS, Nelson MJ, Taylor M, et al.: Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2018; 26: 847–863. 7) Iversen MD, Chudasama N, Losina E, et al.: Influence of self-reported limb length discrepancy on function and satisfaction 6 years after total hip replacement. J Geriatr Phys Ther 2011; 34: 148–152. 28) 森本忠嗣，會田勝広，園畑素樹，他：変形性股関節症の脚長差と腰椎側彎の関係Hip-Spine Syndrome．整形外科と災害外科 2010; 59: 586–589. 14) Lim SJ, Park YS: Plain radiography of the hip: a review of radiographic techniques and image features. Hip Pelvis 2015; 27: 125–134. 17) 川端悠士，狩又祐太：人工股関節全置換術後の漸減的な補高挿入は自覚的脚長差の軽減に有用か? 被検者間マルチベースラインデザインを使用した検討．理学療法学 2016; 43: 486–492. 4) Kawabata Y, Kimura M: Relationship of early postoperative perceived leg length discrepancy to the progression of osteoarthritis in the contralateral hip after unilateral total hip arthroplasty-a retrospective cohort study using propensity score matching. J Phys Ther Sci 2023; 35: 300–305. 27) Pheasant MS, Coulter JL, Wallace C, et al.: Lumbar spine fusion and symptoms of leg length discrepancy after hip arthroplasty. J Arthroplasty 2021; 36: 3241–3247. 24) Perron M, Malouin F, Moffet H, et al.: Three-dimensional gait analysis in women with a total hip arthroplasty. Clin Biomech (Bristol, Avon) 2000; 15: 504–515. 8) Kim HS, Lee HJ, Yoo JJ: Minimal pre-operative leg length discrepancy as a risk factor of post-operative leg length discrepancy after total hip arthroplasty: a retrospective study of patients with non-traumatic osteonecrosis of the femoral head. BMC Musculoskelet Disord 2023; 24: 954. 22) Saunders JB, Inman VT, Eberhart HD: The major determinants in normal and pathological gait. J Bone Joint Surg Am 1953; 35: 543–558. |
| References_xml | – reference: 14) Lim SJ, Park YS: Plain radiography of the hip: a review of radiographic techniques and image features. Hip Pelvis 2015; 27: 125–134. – reference: 22) Saunders JB, Inman VT, Eberhart HD: The major determinants in normal and pathological gait. J Bone Joint Surg Am 1953; 35: 543–558. – reference: 27) Pheasant MS, Coulter JL, Wallace C, et al.: Lumbar spine fusion and symptoms of leg length discrepancy after hip arthroplasty. J Arthroplasty 2021; 36: 3241–3247. – reference: 9) Takemoto G, Osawa Y, Seki T, et al.: A large preoperative pelvic oblique angle affects perception of leg length discrepancy after total hip arthroplasty. J Orthop Sci 2023. doi: 10.1016/j.jos.2023.01.013. – reference: 25) Tateuchi H, Tsukagoshi R, Fukumoto Y, et al.: Dynamic hip joint stiffness in individuals with total hip arthroplasty: relationships between hip impairments and dynamics of the other joints. Clin Biomech (Bristol, Avon) 2011; 26: 598–604. – reference: 19) O’Brien RM: A caution regarding rules of thumb for variance inflation factors. Quality and Quantity 2007; 41: 673–690. – reference: 13) Harris I, Hatfield A, Walton J: Assessing leg length discrepancy after femoral fracture: clinical examination or computed tomography? ANZ J Surg 2005; 75: 319–321. – reference: 1) Faldini C: Leg length discrepancy after primary total hip replacement. Musculoskelet Surg 2023; 107: 1–5. – reference: 4) Kawabata Y, Kimura M: Relationship of early postoperative perceived leg length discrepancy to the progression of osteoarthritis in the contralateral hip after unilateral total hip arthroplasty-a retrospective cohort study using propensity score matching. J Phys Ther Sci 2023; 35: 300–305. – reference: 10) Kinoshita K, Kimura K, Miyamoto S, et al.: Relationship between perceived leg length discrepancy at one month and preoperative hip abductor muscle elasticity in patients after total hip arthroplasty. Phys Ther Res 2021; 24: 232–239. – reference: 11) 川端悠士，後藤圭太，武市理史，他：人工股関節全置換術例における自覚的脚長差に影響を与える要因 階層的重回帰分析を用いた検討．理学療法学 2015; 42: 408–415. – reference: 18) Ieiri A, Tushima E, Ishida K, et al.: Reliability of measurements of hip abduction strength obtained with a hand-held dynamometer. Physiother Theory Pract 2015; 31: 146–152. – reference: 15) Moharrami A, Mirghaderi P, Hoseini Zare N, et al.: Slight pelvic obliquity is normal in a healthy population: a cross-sectional study. J Exp Orthop 2023; 10: 57. – reference: 20) Kozak M, Azevedo RA: Does using stepwise variable selection to build sequential path analysis models make sense? Physiol Plant 2011; 141: 197–200. – reference: 29) Sabharwal S, Kumar A: Methods for assessing leg length discrepancy. Clin Orthop Relat Res 2008; 466: 2910–2922. – reference: 21) Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174. – reference: 7) Iversen MD, Chudasama N, Losina E, et al.: Influence of self-reported limb length discrepancy on function and satisfaction 6 years after total hip replacement. J Geriatr Phys Ther 2011; 34: 148–152. – reference: 17) 川端悠士，狩又祐太：人工股関節全置換術後の漸減的な補高挿入は自覚的脚長差の軽減に有用か? 被検者間マルチベースラインデザインを使用した検討．理学療法学 2016; 43: 486–492. – reference: 2) Iwakiri K, Ohta Y, Fujii T, et al.: Changes in patient-perceived leg length discrepancy following total hip arthroplasty. Eur J Orthop Surg Traumatol 2021; 31: 1355–1361. – reference: 23) Bahl JS, Nelson MJ, Taylor M, et al.: Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2018; 26: 847–863. – reference: 6) Mahmood SS, Mukka SS, Crnalic S, et al.: The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty 2015; 30: 1638–1642. – reference: 3) Waibel FWA, Berndt K, Jentzsch T, et al.: Symptomatic leg length discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res 2021; 107: 102761. – reference: 12) Koga D, Jinno T, Okawa A, et al.: The effect of preoperative lateral flexibility of the lumbar spine on perceived leg length discrepancy after total hip arthroplasty. J Med Dent Sci 2009; 56: 69–77. – reference: 5) Nakanowatari T, Suzukamo Y, Suga T, et al.: True or apparent leg length discrepancy: which is a better predictor of short-term functional outcomes after total hip arthroplasty? J Geriatr Phys Ther 2013; 36: 169–174. – reference: 26) Omichi Y, Goto T, Wada K, et al.: Impact of the hip-spine relationship and patient-perceived leg length discrepancy after total hip arthroplasty: A retrospective study. J Orthop Sci 2023: S0949-2658(23)00088-X. doi: 10.1016/j.jos.2023.03.018. – reference: 28) 森本忠嗣，會田勝広，園畑素樹，他：変形性股関節症の脚長差と腰椎側彎の関係Hip-Spine Syndrome．整形外科と災害外科 2010; 59: 586–589. – reference: 24) Perron M, Malouin F, Moffet H, et al.: Three-dimensional gait analysis in women with a total hip arthroplasty. Clin Biomech (Bristol, Avon) 2000; 15: 504–515. – reference: 8) Kim HS, Lee HJ, Yoo JJ: Minimal pre-operative leg length discrepancy as a risk factor of post-operative leg length discrepancy after total hip arthroplasty: a retrospective study of patients with non-traumatic osteonecrosis of the femoral head. BMC Musculoskelet Disord 2023; 24: 954. – reference: 16) Kitajima M, Mawatari M, Aita K, et al.: A simple method to determine the pelvic inclination angle based on anteroposterior radiographs. J Orthop Sci 2006; 11: 342–346. |
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| Title | 人工股関節全置換術後早期における歩行時の自覚的脚長差に関連する因子 |
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