髋关节为何重要：前交叉韧带重建术后骨盆不稳由髋外展肌动态控制而非最大力量驱动——基于644例患者的三维分析
简介
本研究纳入644例前交叉韧带（ACL）重建术后5-7个月患者，通过三维运动分析同步测力台，评估跑步、单腿跳及落地动作中骨盆与髋关节的动态控制能力，并与臀中肌等长肌力进行对比。关键发现：患侧骨盆和躯干摆动是骨盆下降的主要预测因素（似然比χ²=96-174，p<0.001），伴随膝关节屈曲减少；落地时骨盆倾斜增加与接触时间延长、跳跃高度降低及躯干倾斜增大相关，提…
英文摘要
PURPOSE: To investigate the association between maximal isometric gluteus medius (GM) strength and pelvic/hip control during running and single-leg landings and to evaluate the efficacy of 3D kinematic and kinetic measures of dynamic hip abductor control, compared with maximal strength, for assessing pelvic instability of the operated limb 5-7 months after anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 644 patients were analysed 5-7 months after primary ACL reconstruction. Each subject performed the following exercises: running (run pelvic drop [RPD]), single-leg drop jump and single-leg hop, with 3D analysis synchronised to force platforms. Isometric abduction strength was assessed using the VALD system. Binary and ordinal logistic analyses (likelihood ratio [LR] type II test, false discovery rate [FDR] correction) identified predictors of proximal instability on the operated and contralateral sides. RESULTS: On the operated side, pelvic and trunk oscillations were the main predictors of greater pelvic drop (LR χ² = 96-174, p < 0.001), with less knee flexion. In the drop jump, greater pelvic tilt was associated with longer contact time (LR χ² = 42.7, p < 0.001), lower jump height and greater trunk inclination, indicating a rigid landing strategy. The isometric strength of the GM and quadriceps showed no significant associations with RPD except for the knee flexors that showed a modest effect on RPD (LR χ² = 6.09/6.4, p ≈ 0.013/0.04). On the healthy side, the same variables were present but with less intensity, suggesting stable compensatory behaviour. CONCLUSION: At 5-7 months after ACL reconstruction, proximal instability is specific to the operated limb and depends on deficits in coordination and neuromuscular timing rather than on strength deficiencies. Dynamic parameters describe pelvic stability more accurately than isometric strength. LEVEL OF EVIDENCE: Level III, retrospective cross-sectional study on a prospectively enrolled cohort.