Muscle fatigue in arthritis total hip replacement

关节炎全髋关节置换术中的肌肉疲劳

• 批准号: 6356335
• 负责人: GINA E. BERTOCCI
• 金额: $ 11.42万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-25 至 2001-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6356335
• 关键词: biomechanics; clinical research; electromyography; exercise; fatigue; functional ability; hip prosthesis; human subject; medical rehabilitation related tag; muscle strength; osteoarthritis; postoperative state; rehabilitation

Background: More than 124,000 total hip replacement (THR) surgeries are performed annually in the US in an effort to increase mobility and comfort in those having arthritic, deteriorated or injured hips. The most common preoperative diagnosis for THR is osteoarthritis. As indicated in the NIH Total Hip Replacement Consensus Conference, questions remain concerning rehabilitation approaches which yield the best long-term outcomes. No previous investigations regarding the influence of muscle fatigue in THR patients have been identified. Muscle fatigue and endurance can significantly affect mobility1 function and the risk of secondary injury in this patient population. Aim/Hypothesis: This study seeks to evaluate muscle fatigue in arthritis patients who have undergone total hip replacement (THR) surgery as a means to assess rehabilitation status. The primary hypothesis of our study is that THR patients exhibit increased rates and levels of fatigue placing this population at higher risk for falls, joint dislocations and other injuries. Should this hypothesis prove conclusive, rehabilitation evaluation and training strategies should be expanded to address endurance. Methods. A combination of EMG measures and joint kinetic analysis will be utilized to assess THR patient response to mild muscle fatigue. Test conditions will include dynamometer submaximal (80% MVC) isometric and isokinetic exercises. Response of the patient group's operated hip will be compared to the unoperated hip, as well as to a control group. THR subjects will be assessed postoperatively between 4 and 5 months. Self-assessment of physical and social function will also be evaluated using the MOSS-SF 36, HAQ and MAQ. Preliminary Results/Findings: Our preliminary data from a pilot study (10 cases and 10 controls) funded by the Western Pa. Chapter of the Arthritis Foundation indicates that differences exist between cases and controls in muscle fatigue/endurance and self-assessed physical and social function. Across all biomechanical measures THR cases have lower performance or outcome. Statistically significant differences were found between cases and controls in isokinetic performance associated with hip flexion, extension and abduction. Cases also differed significantly from controls in the level of muscle fatigue associated with 80% MVC exercises as measured by median bower frequency shift. We further observed lower isokinetic performance in case operated hips than unoperated hips. Significant differences were found between operated and unoperated isokinetic performance in hip flexion. Self-assessment of THR cases as measured using the MOSS-SF36 was also consistent lower than that of control subjects.

工作背景：在美国，每年进行超过124，000例全髋关节置换术（THR）手术，以提高关节炎，恶化或受伤髋关节的活动性和舒适度。THR最常见的术前诊断是骨关节炎。正如NIH全髋关节置换共识会议所指出的，关于产生最佳长期结果的康复方法仍然存在问题。以前没有关于THR患者肌肉疲劳影响的研究。肌肉疲劳和耐力可显著影响该患者人群的活动功能和继发性损伤风险。目的/假设：本研究旨在评估关节炎患者接受全髋关节置换术（THR）手术后的肌肉疲劳，以评估康复状况。我们研究的主要假设是THR患者表现出更高的疲劳率和疲劳水平，使这一人群发生福尔斯、关节脱位和其他损伤的风险更高。如果这一假设被证明是结论性的，康复评估和训练策略应扩大到解决耐力。方法. EMG测量和关节动力学分析的组合将用于评估THR患者对轻度肌肉疲劳的反应。测试条件将包括测力计次最大（80%MVC）等长和等速运动。将患者组手术髋关节的反应与未手术髋关节以及对照组进行比较。THR受试者将在术后4 - 5个月进行评估。还将使用MOSS-SF 36、HAQ和MAQ评价身体和社会功能的自我评估。初步结果/发现：我们的初步数据来自一项试点研究（10例和10个对照）由西宾夕法尼亚州。关节炎基金会的第一章指出，在肌肉疲劳/耐力和自我评估的身体和社会功能方面，病例和对照组之间存在差异。在所有生物力学测量中，THR病例的性能或结局较低。病例组和对照组在髋关节屈曲、伸展和外展等动力学表现方面存在统计学显著差异。病例组与对照组在80%MVC运动相关的肌肉疲劳水平上也有显著差异，这是通过中位鲍尔频率偏移来测量的。我们进一步观察到手术髋关节的等速性能低于未手术髋关节。在髋关节屈曲方面，手术和未手术的等速性能之间存在显著差异。使用MOSS-SF 36测量的THR病例的自我评估也一致低于对照受试者。