Payne Emma R, Harris Michael D, Harris-Hayes Marcie, Nahal Chadi, Kamenaga Tomoyuki, Clohisy John C, Pascual-Garrido Cecilia
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Saint Louis University School of Medicine, St. Louis, Missouri, USA.
J Orthop Res. 2023 Apr;41(4):852-861. doi: 10.1002/jor.25426. Epub 2022 Aug 20.
Developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) are common hip pathologies and important risk factors for osteoarthritis, yet the disease mechanisms differ. DDH involves deficient femoral head coverage and a shortened abductor moment arm, so this study hypothesized that the cross-sectional area (CSA) of the gluteus medius/minimus muscle complex and the stabilizing iliocapsularis muscle would be larger in DDH versus FAI, without increased fatty infiltration. A longitudinal cohort identified prearthritic patients with DDH or FAI who underwent imaging before surgery. Patients with DDH and FAI (Cam, Pincer, or Mixed) were 1:1 matched based on age, sex, and body mass index. Magnetic resonance imaging was used to measure the gluteus medius/minimus complex and iliocapsularis in two transverse planes. Amira software was used to quantify muscle and noncontractile tissue. Paired samples t-tests were performed to compare muscle size and composition (p < 0.05). There were no differences in the iliocapsularis muscle. Patients with DDH had significantly larger CSA of the gluteus medius/minimus complex at both transverse planes, and the noncontractile tissue proportion did not differ. The mean difference in overall muscle CSA at the anterior inferior iliac spine was 4.07 ± 7.4 cm (p = 0.005), with an average difference of 12.1%, and at the femoral head this was 2.40 ± 4.37 cm (p = 0.004), with an average difference of 20.2%. This study reports a larger CSA of the gluteus medius/minimus muscle complex in DDH compared to FAI, without a difference in noncontractile tissue, indicating increased healthy muscle in DDH.
发育性髋关节发育不良（DDH）和股骨髋臼撞击症（FAI）是常见的髋关节疾病，也是骨关节炎的重要危险因素，但二者的发病机制不同。DDH涉及股骨头覆盖不足和外展肌力矩臂缩短，因此本研究假设，与FAI相比，DDH患者臀中肌/臀小肌复合体和稳定的髂囊肌的横截面积（CSA）会更大，且脂肪浸润不会增加。一项纵向队列研究纳入了术前接受影像学检查的DDH或FAI的关节炎前期患者。根据年龄、性别和体重指数，将DDH和FAI（凸轮型、钳夹型或混合型）患者进行1:1匹配。采用磁共振成像在两个横断面上测量臀中肌/臀小肌复合体和髂囊肌。使用Amira软件对肌肉和非收缩组织进行量化。采用配对样本t检验比较肌肉大小和组成（p < 0.05）。髂囊肌没有差异。DDH患者在两个横断面上臀中肌/臀小肌复合体的CSA均显著更大，且非收缩组织比例没有差异。在髂前下棘处，总体肌肉CSA的平均差异为4.07±7.4 cm²（p = 0.005），平均差异为12.1%；在股骨头处，平均差异为2.40±4.37 cm²（p = 0.004），平均差异为20.2%。本研究报告称，与FAI相比，DDH患者臀中肌/臀小肌复合体的CSA更大，非收缩组织无差异，表明DDH患者健康肌肉增加。
