Luginsland Lauren A, Stevens Wilshaw R, Loewen Alex M, Tulchin-Francis Kirsten
Scottish Rite for Children, Dallas, TX, USA.
Scottish Rite for Children, Dallas, TX, USA.
Clin Biomech (Bristol). 2020 Dec;80:105196. doi: 10.1016/j.clinbiomech.2020.105196. Epub 2020 Oct 14.
Compensatory mechanisms for hip pain, pathology, and weakness include excessive trunk lean towards the stance limb, counteracting pelvic drop to maintain stability during single leg stance. Trunk lean shifts the center of mass towards the hip joint center to decrease the moment arm and reduce hip abductor demand. The purpose of this study was to evaluate whether adolescent patients with symptomatic hip pain demonstrate excessive trunk lean and the effect on the hip abductor moment impulse.
Self-selected speed walking data collected through an approved study were reviewed on pre-operative patients clinically diagnosed with a hip deformity. Instrumented motion analysis was performed to analyze trunk kinematics and the hip abductor moment impulse.
There was a weak, but significant correlation between hip abductor moment impulse and trunk lean. Patients diagnosed with Acetabular Dysplasia demonstrated an increased trunk lean and a decreased hip abductor moment impulse (r = - 0.311, p = 0.001). Of those who presented with excessive trunk lean, 62% of these patients had a normal hip abductor moment impulse. There was no correlation between hip abductor moment impulse and hip abductor strength.
Excessive trunk lean was not seen uniformly across adolescent patients with symptomatic hip deformities, despite pain being reported in 80% of patients. Furthermore, a majority of those that presented with excessive trunk lean did not present with a reduced moment, suggesting that although the amount of lean was greater than normal, it was not enough to significantly reduce the demand on the hip musculature.
髋关节疼痛、病变及无力的代偿机制包括躯干过度向支撑腿倾斜，以抵消单腿站立时骨盆下降，从而维持稳定性。躯干倾斜使重心向髋关节中心移动，以减小力臂并降低髋关节外展肌的需求。本研究的目的是评估有症状的青少年髋关节疼痛患者是否表现出过度的躯干倾斜以及对髋关节外展肌力矩冲量的影响。
对通过一项获批研究收集的、临床诊断为髋关节畸形的术前患者的自选速度行走数据进行回顾。进行仪器化运动分析以分析躯干运动学和髋关节外展肌力矩冲量。
髋关节外展肌力矩冲量与躯干倾斜之间存在微弱但显著的相关性。诊断为髋臼发育不良的患者表现出躯干倾斜增加和髋关节外展肌力矩冲量降低（r = -0.311，p = 0.001）。在那些表现出过度躯干倾斜的患者中，62%的患者髋关节外展肌力矩冲量正常。髋关节外展肌力矩冲量与髋关节外展肌力量之间无相关性。
尽管80%的患者报告有疼痛，但在有症状的青少年髋关节畸形患者中，并非普遍存在过度的躯干倾斜。此外，大多数表现出过度躯干倾斜的患者力矩并未降低，这表明尽管倾斜程度大于正常，但不足以显著降低对髋关节肌肉组织的需求。
