Are Abnormal Muscle Biomechanics and Patient-reported Outcomes Associated in Patients With Hip Dysplasia?
Are Abnormal Muscle Biomechanics and Patient-reported Outcomes Associated in Patients With Hip Dysplasia?
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DOI：
10.1097/corr.0000000000002728
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发表时间：
2023-06
影响因子：
4.2
通讯作者：
Tina Wu;K. Lohse;L. V. van Dillen;Ke Song;J. Clohisy;M. Harris
中科院分区：
文献类型：
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作者：
Tina Wu;K. Lohse;L. V. van Dillen;Ke Song;J. Clohisy;M. Harris
摘要背景发育性髋关节发育不良（DDH）是髋关节骨关节炎早期发生的主要危险因素。最近的研究表明，DDH如何改变髋关节肌肉力矩臂，提高肌肉诱导的生物力学变量，如关节反作用力和髋臼边缘负荷。了解异常生物力学与患者报告结局指标（PROM）之间的联系对于改善患者症状和功能结局的循证临床干预非常重要。据我们所知，有没有报告之间的关系肌肉诱导的生物力学和PROM。问题/目的（1）对于DDH患者和对照组，在步态期间PROM和肌肉诱导的髋关节生物力学之间是否存在关联？(2)PROM之间以及生物力学变量之间是否存在关联？方法本前瞻性横断面比较研究的参与者包括20例既往无手术史或骨关节炎的女性DDH患者和15例无髋关节病理证据的女性个体（对照组）（年龄：中位数23岁[范围16至39岁]; BMI：中位数22 kg/m2 [范围17至27 kg/m2]）。报告了该队列的肌肉诱导生物力学变量，并根据患者特定的肌肉骨骼模型、运动数据和MRI计算。生物力学变量包括关节反作用力、髋臼边缘载荷、髋关节中心偏侧和臀中肌力矩臂长度。PROM包括髋关节残疾和骨关节炎结局评分（HOOS）、WOMAC、国际髋关节结局工具-12、美国国立卫生研究院患者报告结局测量信息系统（PROMIS）疼痛干扰和身体功能子量表以及加州大学洛杉矶活动量表。使用斯皮尔曼等级顺序相关性检验PROM和生物力学变量之间的关联，并使用Benjamini-Yekutieli方法进行多重比较校正。对于本研究，当相关性具有统计学显著性（p < 0.05）且为强（ρ ≥ 0.60）或中度（ρ = 0.40至0.59）时，认为变量之间存在相关性。结果髋臼边缘负荷脉冲（整个步态周期的累积髋臼边缘负荷），内侧关节反作用力，髋关节中心偏侧最常见的表现为中度或强烈的相关性与PROM。最强的相关性是上级髋臼上的髋臼边缘负荷脉冲与日常生活子量表中的HOOS功能之间的负相关（ρ = -0.63; p = 0.001），其次是髋关节中心偏侧与HOOS疼痛子量表之间的负相关（ρ = -0.6; p = 0.003），髋关节中心偏侧与PROMIS疼痛子量表呈正相关（ρ = 0.62; p = 0.002）。加州洛杉矶大学的活动量表是唯一一个未显示与任何生物力学变量相关的PROM。除加州大学洛杉矶活动量表外，所有PROM均相互关联。虽然大多数的生物力学变量是相互关联的，这些关系并不一致的PROM之间。结论：在当前研究中检测到的与PROM的关联表明，肌肉诱导的生物力学可能不仅对髋关节内的负荷，而且对患者对其健康和功能的感知具有广泛的影响。随着DDH治疗的发展，针对患者的关节保护策略可能会受益于针对与PROM相关的生物力学结果的根本原因。证据等级III，预后研究。
Abstract Background Developmental dysplasia of the hip (DDH) is a major risk factor for the early development of hip osteoarthritis. Recent studies have demonstrated how DDH alters hip muscle moment arms and elevates muscle-induced biomechanical variables such as joint reaction forces and acetabular edge loads. Understanding the link between abnormal biomechanics and patient-reported outcome measures (PROMs) is important for evidence-based clinical interventions that improve patient symptoms and functional outcomes. To our knowledge, there are no reports of the relationships between muscle-induced biomechanics and PROMs. Questions/purposes (1) Are there associations between PROMs and muscle-induced hip biomechanics during gait for patients with DDH and controls? (2) Are there associations among PROMs and separately among biomechanical variables? Methods Participants in this prospective cross-sectional comparative study included 20 female patients with DDH who had no prior surgery or osteoarthritis and 15 female individuals with no evidence of hip pathology (controls) (age: median 23 years [range 16 to 39 years]; BMI: median 22 kg/m2 [range 17 to 27 kg/m2]). Muscle-induced biomechanical variables for this cohort were reported and had been calculated from patient-specific musculoskeletal models, motion data, and MRI. Biomechanical variables included joint reaction forces, acetabular edge loads, hip center lateralization, and gluteus medius muscle moment arm lengths. PROMs included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the WOMAC, International Hip Outcome Tool-12, National Institutes of Health Patient-Reported Outcome Measure Information System (PROMIS) Pain Interference and Physical Function subscales, and University of California Los Angeles activity scale. Associations between PROMs and biomechanical variables were tested using Spearman rank-order correlations and corrected for multiple comparisons using the Benjamini-Yekutieli method. For this study, associations between variables were considered to exist when correlations were statistically significant (p < 0.05) and were either strong (ρ ≥ 0.60) or moderate (ρ = 0.40 to 0.59). Results Acetabular edge load impulses (the cumulative acetabular edge load across the gait cycle), medially directed joint reaction forces, and hip center lateralization most commonly demonstrated moderate or strong associations with PROMs. The strongest associations were a negative correlation between acetabular edge load impulse on the superior acetabulum and the HOOS function in daily living subscale (ρ = -0.63; p = 0.001), followed by a negative correlation between hip center lateralization and the HOOS pain subscale (ρ = -0.6; p = 0.003), and a positive correlation between hip center lateralization and the PROMIS pain subscale (ρ = 0.62; p = 0.002). The University of California Los Angeles activity scale was the only PROM that did not demonstrate associations with any biomechanical variable. All PROMs, aside from the University of California Los Angeles activity scale, were associated with one another. Although most of the biomechanical variables were associated with one another, these relationships were not as consistent as those among PROMs. Conclusion The associations with PROMs detected in the current study suggest that muscle-induced biomechanics may have wide-reaching effects not only on loads within the hip, but also on patients’ perceptions of their health and function. As the treatment of DDH evolves, patient-specific joint preservation strategies may benefit from targeting the underlying causes of biomechanical outcomes associated with PROMs. Level of Evidence Level III, prognostic study.