Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, Australia.
School of Health & Rehabilitation Sciences, University of Queensland, Saint Lucia, Australia.
Gait Posture. 2018 Mar;61:459-465. doi: 10.1016/j.gaitpost.2018.02.011. Epub 2018 Feb 12.
Gluteal tendinopathy (GT) and hip osteoarthritis (OA) are the most common causes of hip pain and associated disability in older adults. Pain and altered walking biomechanics are common to both conditions. This study aimed to compare three-dimensional walking biomechanics between individuals with unilateral, symptomatic GT and HOA.
Sixty individuals with symptomatic unilateral GT confirmed by magnetic-resonance-imaging and 73 individuals with symptomatic unilateral HOA (Kellgren-Lawrence Grade ≥ 2) underwent three-dimensional gait analysis. Maximum and minimum values of the external sagittal hip moment, the first peak, second peak and mid-stance minimum of the hip adduction moment (HAM), sagittal plane hip excursion and hip joint angles, pelvic obliquity and trunk lean, at the three HAM time points during stance phase of walking were compared between groups.
Compared to individuals with HOA, those with GT exhibited a greater hip peak extension moment (P < 0.001) and greater HAM throughout the stance phase of walking (P = 0.01-P < 0.001), greater hip adduction (P < 0.001) and internal rotation (P < 0.01-P < 0.001) angles and lower hip flexion angles and excursion (P = 0.02 - P < 0.001). Individuals with HOA exhibited a greater forward trunk lean (P ≤ 0.001) throughout stance, and greater ipsilateral trunk lean in the frontal plane (P < 0.001) than those with GT.
Despite presence of pain in both conditions, hip kinematics and kinetics differ between individuals with symptomatic unilateral GT and those with symptomatic unilateral HOA. These condition-specific impairments may be targets for optimization of management of HOA and GT.
臀肌腱病（GT）和髋骨关节炎（OA）是导致老年人髋部疼痛和相关残疾的最常见原因。这两种疾病都有疼痛和改变的步行生物力学。本研究旨在比较单侧、症状性 GT 和 OA 患者的三维步行生物力学。
60 名经磁共振成像证实的单侧 GT 患者和 73 名单侧 HOA 患者（Kellgren-Lawrence 分级≥2）进行了三维步态分析。比较了两组在行走的站立相三个 HAM 时间点时髋关节外展力矩的最大和最小值、髋关节内收力矩（HAM）的第一峰值、第二峰值和中驻留最小、矢状面髋关节活动度和髋关节角度、骨盆倾斜度和躯干倾斜度。
与 OA 患者相比，GT 患者的髋关节峰值伸展力矩更大（P<0.001），行走时整个站立相的 HAM 更大（P=0.01-P<0.001），髋关节内收和内旋角度更大（P<0.001），髋关节屈曲角度和活动度更小（P=0.02-P<0.001）。OA 患者在整个站立相都有更大的前躯干倾斜（P≤0.001），而在额状面中更同侧的躯干倾斜（P<0.001）比 GT 患者更大。
尽管两种疾病都有疼痛，但有症状的单侧 GT 患者和有症状的单侧 OA 患者的髋关节运动学和动力学存在差异。这些特定于疾病的损伤可能是优化 OA 和 GT 管理的目标。
