Yilmaz Serdar, Yüksel Halil Yalçn, Aksahin Ertuğrul, Celebi Levent, Ersöz Murat, Muratli Hasan Hilmi, Biçimoğlu Ali
Third Orthopaedics and Traumatology Clinic, Ankara Numune Educational and Research Hospital, Ankara, Turkey.
J Pediatr Orthop. 2010 Jan-Feb;30(1):44-9. doi: 10.1097/BPO.0b013e3181c6b390.
To assess the isokinetic muscle strength (IMS) of hip flexor and extensor muscles in patients treated with one-stage combined procedure for developmental dysplasia of the hip and analyze the effect of the status of hip muscles on IMS.
Twenty-two patients were included in the study. The mean age was 154.4+/-34.6 (110-216) months and the mean follow-up was 112.6+/-32.0 (68-159) months. All patients underwent complete tenotomy of the iliopsoas muscle to ease open reduction and had excellent results according to the modified McKay criteria of Barrett and type I hips according to the radiologic criteria of Severin. All patients had earlier magnetic resonance imaging examination that revealed reattachment of the iliopsoas in 7 (32%) patients. IMS measurements were performed at 120 degrees/s and 240 degrees/s. The peak torque (PT), PT angle, total work (TW), and average power (AP) values of operated and nonoperated hips were recorded separately for flexors and extensors.
For flexors, TW and AP values were lower at the operated hip when compared with the nonoperated hip at both angular velocities. PT was only lower at the operated hip at 120 degrees/s. For extensor muscles, PT, TW, AP, and PT angle showed no statistically significant difference at either angular velocity. For flexors, the PT deficit between the operated and nonoperated hips at 120 degrees/s and 240 degrees/s was measured as 15.3% and 8.0%, respectively. There was no difference between the flexor muscles of operated and nonoperated hips considering PT, TW, and AP at both angular velocities in patients with reattachment. The IMS deficit of flexor muscles at 120 degrees/s was significantly higher in patients without reattachment of iliopsoas when compared with those with reattachment, and correlated to the widths of the iliopsoas muscle at levels II and III.
Assessing the results of surgical treatment of DDH with conventional radiologic and functional criteria might be misleading in some patients with excellent results because some of these patients, particularly those without reattachment of the iliopsoas muscle, experience significant weakness in hip flexion.
评估接受一期联合手术治疗发育性髋关节发育不良患者的髋部屈肌和伸肌等速肌力（IMS），并分析髋部肌肉状态对IMS的影响。
本研究纳入22例患者。平均年龄为154.4±34.6（110 - 216）个月，平均随访时间为112.6±32.0（68 - 159）个月。所有患者均接受髂腰肌完全切断术以利于切开复位，根据Barrett改良的McKay标准结果优良，根据Severin放射学标准为I型髋。所有患者均较早进行磁共振成像检查，发现7例（32%）患者髂腰肌重新附着。在120°/s和240°/s下进行IMS测量。分别记录手术侧和非手术侧髋部屈肌和伸肌的峰值扭矩（PT）、PT角度、总功（TW）和平均功率（AP）值。
对于屈肌，在两个角速度下，手术侧髋部的TW和AP值均低于非手术侧髋部。仅在120°/s时手术侧髋部的PT较低。对于伸肌，在任一角速度下，PT、TW、AP和PT角度均无统计学显著差异。对于屈肌，手术侧和非手术侧髋部在120°/s和240°/s时的PT差值分别为15.3%和8.0%。在重新附着的患者中，手术侧和非手术侧髋部屈肌在两个角速度下的PT、TW和AP无差异。与有重新附着的患者相比，髂腰肌未重新附着的患者在120°/s时屈肌的IMS差值显著更高，且与II级和III级水平的髂腰肌宽度相关。
对于一些手术效果优良的发育性髋关节发育不良患者，用传统放射学和功能标准评估手术治疗结果可能会产生误导，因为这些患者中的一些人，尤其是那些髂腰肌未重新附着的患者，存在明显的髋部屈曲无力。
