Muscle Geometry and its Influence on Function in Patients with Developmental Dysplasia of the Hip

项目总结 发育性髋关节发育不良(DDH)显著增加髋关节早期发育的风险 青少年和年轻人的骨关节炎(OA)。在DDH的情况下， 髋臼(髋窝)和股骨改变关节内的负荷，这可能导致髋臼唇痛。 撕裂和关节软骨损伤。如果不纠正，这种关节损害会进展到骨性关节炎，并可能需要 全关节置换。疼痛和身体受限是DDH患者的常见症状。然而， 症状的表现、强度和组合并不总是与骨质疏松症的放射征象相一致。 异常或软组织损伤。骨骼结构以外的因素，如肌肉功能，可能会起作用 出现症状和关节负荷改变，但肌肉在DDH病理力学中的作用不是很好 明白了。这个项目将是第一个严格研究骨骼-肌肉关系作为一个因素的项目 DDH患者的病理力学和症状学特点。在目标1中，我们将使用磁共振成像 (MRI)和肌肉骨骼模型，以比较臀部肌肉体积、3D肌肉瞬间手臂和肌肉 DDH患者与正常对照组之间的力量差异。AIM 1将提供首个肌肉的3D分析 DDH患者的几何和力矩臂，并可能阐明肌肉改变之间的关系， 骨骼异常的严重程度和肌肉无力。在目标2中，我们将使用3D运动捕捉来量化 髋关节的运动和负荷活动对生物力学的需求越来越大。分析一系列 我们的DDH患者常见的活动可以识别患者和 控制导致症状和关节损伤的受试者。在目标3中，我们将确定翻译 我们的实验室指标和患者报告结果(PRO)的临床指标之间的关系。 识别这种关系可以在患者评估的重要领域之间建立新的联系- 实验室测量和临床研究。最终，我们寻求手术和非手术的协调 优化关节负荷和平衡肌肉使用的方法，以改善治疗并延迟患者的骨关节炎 使用DDH。因此，在探索性目标4中，我们将比较骨骼肌肉的几何形状、力量、髋关节力学、 并对保髋术后一年的临床值和判定变量进行预测 手术后的结果。该建议建立在候选人先前在关节内力学方面的工作和 并提供MRI、力量测试、建模和临床研究方面的新培训 髋关节疾病患者。导师团队由物理治疗师、整形外科医生和 生物工程师，是肌肉结构功能、核磁共振、骨关节炎开发和临床干预方面的专家 DDH。综上所述，该提案的结果将为关注关键因素的R01提供初步数据 影响DDH手术和非手术治疗后患者预后的因素。

PROJECT SUMMARY Developmental dysplasia of the hip (DDH) dramatically increases risk for early development of hip osteoarthritis (OA) in adolescents and young adults. In cases of DDH, abnormal development of the acetabulum (hip socket) and femur alter loading inside the joint, which can lead to painful acetabular labrum tears and articular cartilage lesions. Without correction, this joint damage progresses to OA and may require total joint replacement. Pain and physical limitation are common symptoms in patients with DDH. However, the presentation, intensity and combination of symptoms do not always correspond with radiographic signs of bony abnormalities or soft-tissue damage. Factors beyond bony structure, such as muscle function, likely contribute to symptom onset and altered joint loading, but the role of muscle in DDH pathomechanics is not well understood. This project will be the first to rigorously investigate the bone-muscle relationship as a factor in pathomechanics and symptomatology in patients with DDH. In Aim 1, we will use magnetic resonance imaging (MRI) and musculoskeletal models to compare hip muscle volumes, 3D muscle moment arms, and muscle strength between patients with DDH and control subjects. Aim 1 will provide the first 3D analyses of muscle geometry and moment arms in patients with DDH, and may elucidate relationships among muscle alterations, the severity of bony abnormalities, and muscle weakness. In Aim 2, we will use 3D motion capture to quantify hip movement and loading during activities of increasing biomechanical demand. Analyzing a range of activities that are common for our patients with DDH can identify mechanical distinctions between patients and control subjects that contribute to symptoms and joint damage. In Aim 3, we will identify translational relationships between our laboratory measures and clinical measures of patient reported outcomes (PROs). Identifying such relationships can establish novel links between important realms of patient evaluation – laboratory measurement and clinical research. Ultimately, we seek coordinated surgical and nonsurgical approaches that optimize joint loading and balance muscle use to improve treatment and delay OA for patients with DDH. Thus, in an exploratory Aim 4, we will compare bone-muscle geometry, strength, hip mechanics, and PROs one year after hip preservation surgery to pre-surgical values and determine the variables predictive of post-surgical outcomes. This proposal builds on the candidate's prior work in intra-articular mechanics and bone morphology and provides new training in MRI, strength testing, modeling, and clinical research with patients with hip disorders. The mentor team consists of physical therapists, orthopedic surgeons and bioengineers who are experts in muscle structure-function, MRI, OA development, and clinical intervention for DDH. Together, the results from this proposal will provide preliminary data for an R01 focused on key factors that affect patient outcomes after surgical and nonsurgical intervention for DDH.