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骨盆活动度增加及髋部肌肉收缩模式改变:凸轮型股骨髋臼撞击症矫正手术的两年随访

Increased pelvic mobility and altered hip muscles contraction patterns: two-year follow-up cam-FAIS corrective surgery.

作者信息

Catelli Danilo S, Kowalski Erik, Beaulé Paul E, Lamontagne Mario

机构信息

School of Human Kinetics, University of Ottawa, Ottawa, ON, 200 Lees Ave (E020), Canada.

Ministry of Education of Brazil, CAPES Foundation, Brasilia, DF, Brazil.

出版信息

J Hip Preserv Surg. 2019 Jun 10;6(2):140-148. doi: 10.1093/jhps/hnz019. eCollection 2019 Jul.

Abstract

Femoroacetabular impingement syndrome (FAIS) surgery can produce improvements in function and patient satisfaction; however, data on muscle assessment and kinematics of high mobility tasks of post-operative patients is limited. The purpose of this study was to evaluate kinematics and muscle activity during a deep squat task, as well as muscle strength in a 2-year follow-up FAIS corrective surgery. Eleven cam morphology patients underwent motion and electromyography capture while performing a squat task prior and 2-years after osteochondroplasty and were BMI-, age- and sex-matched to 11 healthy control (CTRL) participants. Isometric muscle strength, flexibility and patient-reported outcome measures (PROMs) were also evaluated. Post-operative FAIS was significantly weaker during hip flexion (23%) and hip flexion-with-abduction (25%) movements when compared with CTRL, no improvements in squat depth were observed. However, post-operative FAIS increased the pelvic range of motion during the squat descent ( = 0.016) and ascent (P = 0.047). They had greater peak activity for the semitendinosus and total muscle activity for the gluteus medius, but decreased peak activity for the glutei and rectus femoris during squat descent; greater total muscle activity for the tensor fascia latae was observed during squat ascent ( = 0.005). Although not improving squat depth, post-operative patients increased pelvic ROM and showed positive PROMs. The muscle weakness associated with hip flexion and flexion-with-abduction observed at the follow-up can be associated with the alterations in the muscle activity and neuromuscular patterns. Rehabilitation programs should focus on increasing pelvis and hip muscles flexibility and strength.

摘要

股骨髋臼撞击综合征(FAIS)手术可改善功能并提高患者满意度;然而,关于术后患者高活动度任务的肌肉评估和运动学数据有限。本研究的目的是评估在2年随访的FAIS矫正手术后,患者在深蹲任务期间的运动学和肌肉活动,以及肌肉力量。11名凸轮形态患者在进行截骨成形术前和术后2年进行深蹲任务时接受了运动和肌电图捕捉,并在体重指数、年龄和性别上与11名健康对照(CTRL)参与者匹配。还评估了等长肌肉力量、柔韧性和患者报告的结局指标(PROMs)。与CTRL相比,术后FAIS在髋关节屈曲(23%)和髋关节屈曲外展(25%)运动时明显较弱,未观察到深蹲深度的改善。然而,术后FAIS在深蹲下降(P = 0.016)和上升(P = 0.047)期间增加了骨盆活动范围。他们在半腱肌的峰值活动更大,臀中肌的总肌肉活动更大,但在深蹲下降期间臀大肌和股直肌的峰值活动降低;在深蹲上升期间观察到阔筋膜张肌的总肌肉活动更大(P = 0.005)。虽然没有改善深蹲深度,但术后患者增加了骨盆活动度并显示出积极的PROMs。随访时观察到的与髋关节屈曲和屈曲外展相关的肌肉无力可能与肌肉活动和神经肌肉模式的改变有关。康复计划应侧重于增加骨盆和髋部肌肉的柔韧性和力量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ce1/6662956/2754abffb1ba/hnz019f1.jpg

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