Gelişimsel kalça displazili erişkin bireylerde alt ekstremite kas kuvveti ile kalça fonksiyonları arasındaki ilişkinin incelenmesi

Abstract

Amaç: Gelişimsel kalça displazili bireylerde kalça çevresi kaslarda değişik derecelerde kas zayıflıkları görülür. Kalça ekleminde fonksiyonelliği belirleyen önemli parametrelerden birisi, günlük yaşam aktiviteleri sırasındaki temel hareketlerdir ve kalça çevresi kaslarının kuvvetini gerektirir. Bu çalışmanın amacı, literatürde gelişimsel kalça displazili bireylerde alt ekstremite kas kuvvetinin kalça fonksiyonları ile ilişkili olup olmadığını araştırmaktır.

Yöntem: Çalışmaya gelişimsel kalça dispazisi tanılı ve total kalça artroplastisi uygulanmamış, yaş ortalaması 40,46±2,28 yıl olan (20-60 yaş arası) 26 kadın hasta dahil edildi. Hastaların kalça fleksörleri, ekstansörleri, abdüktörleri, addüktörleri, iç ve dış rotatörleri, quadriceps femoris ve hamstring kaslarının (medial ve lateral) izometrik kas kuvvetleri dijital el dinamometresi ile kalça fonksiyonları Harris Kalça Skoru ile değerlendirildi.

Bulgular: Harris Skoru ile kalça fleksörleri, ekstansörleri, abdüktörleri, addüktörleri ve lateral hamstringlerin (biseps femoris) kas kuvvetleri arasında pozitif yönde orta seviyede bir ilişki bulunurken (p<0,05), kalça iç ve dış rotatörleri, quadriseps femoris ve medial hamstringler ile herhangi bir ilişki saptanmadı. (p>0,05)

Sonuç: Gelişimsel kalça displazili bireylerde kalça çevresi kas kuvveti ile kalça fonksiyonları arasında yakın bir ilişki vardır. Bu ilişki, kalça fleksörleri, abduktörleri, adduktörleri, lateral hamstringler ve kalça ekstansörleri için geçerlidir ve bu kasların kuvveti azaldıkça kalça fonksiyonları azalmaktadır. Buna karşılık, kalça rotatörleri, quadriseps ve medial hamstringlerin kas kuvvetleri kalça fonksiyonları ile ilişkili değildir. Bu nedenle bu hastalarda iyi bir fonksiyonel seviyenin elde edilmesi için, kalça çevresi kas kuvvetlerinin iyi olması ve tedavide kuvvetlendirme egzersizlerine önem verilmesi gerekmektedir.

Keywords

• Kalça Displazisi
• Alt Ekstremite
• Kas Kuvveti
• Fonksiyon

Investigation of the relationship between lower extremity muscle strength and hip functions in adult individuals with developmental hip dysplasia

Abstract

Purpose: Varying degrees of muscle weakness are observed in muscles of individuals with developmental dysplasia around the hip. One of the important parameters that determine functionality for hip joint is the basic movements during daily living activities and requires hip muscles strength. The aim of this study was to investigate whether lower extremity muscle strength is associated with hip functions in developmental dysplasia subjects.

Method: Twenty-six female patients (mean age 40.46±2.28 years (range, 20-60 years)) with the developmental dysplasia of hip who haven’t undergone total hip arthroplasty were included. Isometric muscle strength of hip flexor, extensor, abductor, adductor, internal rotator, external rotator, quadriceps femoris and hamstring muscles (medial-lateral) was evaluated with hand dynamometer and hip functions was evaluated with Harris Hip Score.

Results: There was a significant positive moderate correlation between Harris Hip Score and hip flexors, extensors, abductors, adductors, and lateral hamstring (biceps femoris) muscle strength (p<0.05), no relationship was found with internal and external rotators, quadriceps femoris and medial hamstrings (p>0.05).

Conclusion: There is a close relationship between hip muscle strength and hip function in individuals with developmental dysplasia of hip. This relationship includes hip flexors, abductors, adductors, lateral hamstrings and hip extensors, and as these muscles’ strength decreases, hip function decreases. In contrast, hip rotators, quadriceps and medial hamstrings strength are not related to hip function. Therefore, in order to achieve a good functional level in these patients, hip muscle strength should be good and strengthening exercises should be given importance in the treatment.

Keywords

• Hip Dysplasia
• Lower Extremity
• Muscle Strength
• Functions

References

1. 1. Ertürk C, Büyükdoğan H. Gelişimsel Kalça Displazisinde Etyoloji ve Tanı (I) İstanbul Kanuni Sultan Süleyman Tıp Dergisi. 2019;11:61-69.
2. 2. Chen J, Zhang W-B, He J-Z, Zhang R, et al. Developmental Dysplasia Of The Hip: A Special Pathology. Chin J Traumatol. 2018;21:238-342.
3. 3. Köse N, Ömeroğlu H, Dağlar B. Gelişimsel Kalça Displazisi Ulusal Erken Tanı ve Tedavi Programı. 2013.
4. 4. Leijendekkers RA, Marra MA, Kolk S, et al. Gait Symmetry And Hip Strength In Women With Developmental Dysplasia Following Hip Arthroplasty Compared To Healthy Subjects: A Cross-Sectional Study. Plos One. 2018;13:1-18.
5. 5. Kolk S, Fluit R, Luijten J, et al. Gait And Lower Limb Muscle Strength In Women After Triple Innominate Osteotomy. BMC Musculoskeletal Disord. 2015;16:68.
6. 6. Ezoe M, Naito M, Asayama I. Muscle Strength Improves After Abductor-Sparing Periacetabular Osteotomy. Clin Orthop Relat Res. 2006;444:161-168.
7. 7. Desteli EE, Imren Y, Tan E, et al. Clinical Results Of Cementless Total Hip Arthroplasty With Shortening Osteotomy For High Dislocation With Developmental Dysplasia. Acta Orthop Belg. 2015;81:30-35.
8. 8. Jacobsen JS, Nielsen DB, Sørensen H, et al. Changes In Walking And Running In Patients With Hip Dysplasia. Acta Orthopaedica. 2013;84:265-270.

9. 9. Jacobsen JS, Hölmich P, Thorborg K, et al. Muscle-Tendon-Related Pain In 100 Patients With Hip Dysplasia: Prevalence And Associations With Self-Reported Hip Disability And Muscle Strength. Journal Of Hip Preservation Surgery. 2017;5:39-46.
10. 10. Pedersen E, Simonsen E, Alkjær T, et al. Walking Pattern In Adults With Congenital Hip Dysplasia 14 Women Examined By Inverse Dynamics. Acta Orthop Scand. 2004;75:2-9.
11. 11. Thorborg K, Petersen J, Magnusson S, et al. Clinical Assessment Of Hip Strength Using A Hand‐Held Dynamometer Is Reliable. Scandinavian Journal Of Medicine & Science In Sports Scand J Med Sci Sports. 2010;20:493-501.
12. 12. Kelln BM, Mckeon PO, Gontkof LM, et al. Hand-Held Dynamometry: Reliability Of Lower Extremity Muscle Testing In Healthy, Physically Active, Young Adults. J Sport Rehabil. 2008;17:160-170.
13. 13. Bohannon RW. Test-Retest Reliability Of Hand-Held Dynamometry During A Single Session Of Strength Assessment. Phys Ther. 1986;66:206-209.
14. 14. Celik D, Can C, Aslan Y, et al. Translation, Cross-Cultural Adaptation, And Validation Of The Turkish Version Of The . Hip International. The Journal Of Clinical And Experimental Research On Hip Pathology And Therapy. 2014;24:473-479.
15. 15. Zeng WN, Liu JL, Wang FY, et al. Total Hip Arthroplasty For Patients With Crowe Type IV Developmental Dysplasia Of The Hip: Ten Years Results. Int J Surg. 2017;42:17-21.
16. 16. Shang D, Zhong S, Zhang X, et al. Surgical Treatment For Osteoarthritis Secondary To Crowe Type IV Developmental Dysplasia Of Hip In Adults. Zhongguo Gu Shang. 2016;29:125-130.
17. 17. Nilsdotter A, Bremander A. Measures Of Hip Function And Symptoms: (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index Of Severity For Osteoarthritis Of The Hip (LISOH), And American Academy Of Orthopedic Surgeons (AAOS) Hip And Knee Questionnaire. Arthritis Care & Research. 2011;63:200-207.
18. 18. Pearson’s correlation. http://www.statstutor.ac.uk/resources/uploaded/pearsons.pdf
19. 19. Zeni Jr J, Pozzi F, Abujaber S, et al. Relationship Between Physical Impairments And Movement Patterns During Gait In Patients With End‐Stage Hip Osteoarthritis. J Orthop Res. 2015;33:382-389.
20. 20. Fukumoto Y, Tateuchi H, Tsukagoshi R, et al. Effects Of High-And Low-Velocity Resistance Training On Gait Kinematics And Kinetics In Individuals With Hip Osteoarthritis: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2017;96:417-423.
21. 21. Gala L, Clohisy JC, Beaulé PE. Hip Dysplasia In The Young Adult. J Bone Joint Surg Am. 2016;98:63-73.
22. 22. Hall M, Wrigley TV, Kasza J, et al. Cross-Sectional Association Between Muscle Strength And Self-Reported Physical Function In 195 Hip Osteoarthritis Patients. Seminars In Arthritis And Rheumatism. 2017;46:387-394.
23. 23. Zeni Jr J, Abujaber S, Pozzi F, et al. Relationship Between Strength, Pain, And Different Measures Of Functional Ability In Patients With End‐Stage Hip Osteoarthritis. Am J Phys Med Rehabil. 2014;66:1506-1512.
24. 24. Nepple JJ, Goljan P, Briggs KK, et al. Hip Strength Deficits In Patients With Symptomatic Femoroacetabular Impingement And Labral Tears. Arthroscopy. 2015;31:2106-2111.
25. 25. Holstege MS, Lindeboom R, Lucas C. Preoperative Quadriceps Strength As A Predictor For Short-Term Functional Outcome After Total Hip Replacement. Arch Phys Med Rehabil. 2011;92:236-241.