Study of changes in the balance of the pelvic girdle muscles in patients with dysplastic coxarthrosis after arthroplasty

IF 6.3 1区 医学 Q1 DERMATOLOGY
O. D. Karpinskaya, M.Y. Karpinsky, O. Tyazhelov, V. Klymovytskyy, L.D. Goncharova, D. Yurchenko
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引用次数: 0

Abstract

Background. Dysplastic coxarthrosis is a special medical and social problem in the treatment of adult patients, often leading to disability, limiting the human’s ability to self-care. Arthroplasty for dysplastic coxarthrosis is only a certain stage in the restoration of the patient’s musculoskeletal function. Considering the large number of unsatisfactory results of arthroplasty in dysplastic coxarthrosis, a very important factor is the construction of a rehabilitation prognosis — the estimated probability of achieving the intended goals of rehabilitation or realization of rehabilitation potential, taking into account disease features and the patient’s capabilities. Objective: to determine the significant parameters of the dysplastic hip joint whose change affects the deficit of lower limb muscle strength after arthroplasty and the prospects for rehabilitation potential. Materials and methods. An X-ray examination of 23 dysplastic hip joints was performed. The following radiometric parameters were measured: acetabular depth; floor thickness; acetabular depth index; abductor moment arm; gravity moment arm; height and lateralization of the center of rotation of the femoral head relative to the center of the acetabulum rotation. To objectify the balance of muscle forces required to maintain pelvic balance when standing on one leg, a mathematical model was used created by the authors, which reflects the pelvis with the femur and the action vectors of the muscles of two groups: abductors and adductors of the hip. Results. Using the model of horizontal balance of the pelvis, the level of muscle strength deficit was calculated in patients before and after arthroplasty. It was found that in some of them the muscle strength deficit remained. With a linear regression model, an equation was created to determine the muscle strength deficit. According to the statistical analysis, no difference was found between the results of the regression equation and the mathematical model (p >> 0.05). The regression analysis has shown that the most significant factors for the result are the neck shaft angle, floor thickness, and head height. To determine the limits of radiometric parameters that affect the outcome of arthroplasty, patients were divided into 4 groups according to the level of calculated muscle strength deficit: group I — deficit of more than 20 %, group II — deficit of less than 20 %, group III — surplus of 20 % and group IV — surplus of more than 20 %. In general, patients improve their muscle strength, but the initial deficit greatly affects the outcome after arthroplasty. For patients in group I, pre- and postoperative rehabilitation is necessary to achieve a positive result. In group II, the main direction of rehabilitation is to increase muscle strength. For patients of groups III and IV, general rehabilitation measures can be used. Conclusions. The most important parameter that affects muscle strength after arthroplasty is the patient’s muscle strength before surgery and weight. Another important indicator is the thickness of the acetabular floor. Weight loss is the main criterion for successful treatment of patients after any arthroplasty.
关节成形术后发育不良髋关节患者骨盆带肌平衡变化的研究
背景。关节发育不良是成人患者治疗中一个特殊的医学和社会问题,往往导致残疾,限制了人的自我照顾能力。关节成形术治疗发育不良的肩关节只是恢复患者肌肉骨骼功能的一个阶段。考虑到关节发育不良患者大量的关节成形术不理想的结果,一个非常重要的因素是康复预后的构建——在考虑疾病特点和患者能力的情况下,估计达到预期康复目标或实现康复潜力的概率。目的:确定发育不良髋关节的重要参数,其改变对髋关节置换术后下肢肌力缺损的影响及康复潜力的前景。材料和方法。对23例发育不良髋关节进行x线检查。测量以下放射学参数:髋臼深度;地板厚度;髋臼深度指数;外展力臂;重力力臂;股骨头旋转中心相对于髋臼旋转中心的高度和偏侧。为了客观化单腿站立时维持骨盆平衡所需的肌肉力量平衡,作者创建了一个数学模型,该模型反映了骨盆与股骨的关系以及髋关节外展肌和内收肌两组肌肉的作用向量。结果。采用骨盆水平平衡模型,计算关节置换术前后患者的肌力缺损水平。结果发现,其中一些人仍然存在肌肉力量不足。通过线性回归模型,建立了确定肌肉力量不足的方程。经统计分析,回归方程结果与数学模型结果无差异(p >> 0.05)。回归分析表明,影响结果最显著的因素是颈轴角、地板厚度和头高。为了确定影响关节置换术结果的放射学参数的限度,根据计算肌力缺损程度将患者分为4组:ⅰ组缺损大于20%,ⅱ组缺损小于20%,ⅲ组剩余20%,ⅳ组剩余20%以上。一般情况下,患者的肌力会得到改善,但关节置换术后的初始缺陷会对结果产生很大影响。对于第一组患者,术前和术后的康复是必要的,以达到积极的结果。第二组以增强肌力为主要康复方向。对于第三组和第四组患者,可采用一般康复措施。结论。影响关节置换术后肌力的最重要参数是患者术前肌力和体重。另一个重要的指标是髋臼底的厚度。体重减轻是任何关节置换术后患者治疗成功的主要标准。
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来源期刊
Burns & Trauma
Burns & Trauma 医学-皮肤病学
CiteScore
8.40
自引率
9.40%
发文量
186
审稿时长
6 weeks
期刊介绍: The first open access journal in the field of burns and trauma injury in the Asia-Pacific region, Burns & Trauma publishes the latest developments in basic, clinical and translational research in the field. With a special focus on prevention, clinical treatment and basic research, the journal welcomes submissions in various aspects of biomaterials, tissue engineering, stem cells, critical care, immunobiology, skin transplantation, and the prevention and regeneration of burns and trauma injuries. With an expert Editorial Board and a team of dedicated scientific editors, the journal enjoys a large readership and is supported by Southwest Hospital, which covers authors'' article processing charges.
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