■股骨髋臼撞击综合征(FAIS)可引起髋关节疼痛和软骨唇损伤,可通过非手术或手术治疗。蹲下运动需要较大的髋关节屈曲度,并支持许多日常和运动任务,但可能会导致髋关节撞击并引起疼痛。以前尚未研究过物理治疗师主导的护理和关节镜对下蹲过程中生物力学的差异影响。这项研究探讨了在物理治疗师主导的干预下治疗的FAIS患者在下蹲时运动学和时间12个月变化的差异(个性化髋关节治疗,PHT)和关节镜检查。
■在多中心注册的FAIS参与者的子样本(n=36),务实,双臂优势随机对照试验在基线下蹲期间和随机分配至PHT(n=17)或关节镜(n=19)后12个月进行了三维运动分析.时间序列和峰值树干的变化,骨盆,和髋关节生物力学,研究了治疗组之间的下蹲速度和最大深度。
■在PHT组和关节镜组之间没有检测到12个月变化的显着差异。与基线相比,关节镜组随访时蹲下较慢(下降:平均差-0.04m·s-1(95CI[-0.09~0.01]);上升:-0.05m·s-1[-0.11~0.01]%)。在组间或组内未检测到深蹲深度的差异。调整速度后,与基线相比,随访时两个治疗组的躯干屈曲均更大(下降:PHT7.50°[-14.02至-0.98]%;上升:PHT7.29°[-14.69至0.12]%,关节镜16.32°[-32.95至0.30]%)。与基线相比,两个治疗组均显示前骨盆倾斜减少(下降:PHT8.30°[0.21-16.39]%,关节镜-10.95°[-5.54至16.34]%;上升:PHT-7.98°[-0.38至16.35]%,关节镜-10.82°[3.82-17.81]%),髋关节屈曲(下降:PHT-11.86°[1.67-22.05]%,关节镜-16.78°[8.55-22.01]%;上升:PHT-12.86°[1.30-24.42]%,关节镜-16.53°[6.72-26.35]%),和膝关节屈曲(下降:PHT-6.62°[0.56-12.67]%;上升:PHT-8.24°[2.38-14.10]%,关节镜-8.00°[-0.02至16.03]%)。与基线相比,PHT组在随访时在深蹲过程中表现出更多的pi屈(-3.58°[-0.12至7.29]%)。与基线相比,两组在随访时都表现出较低的外髋屈曲力矩(下降:PHT-0.55N·m/BW·HT[%][0.05-1.05]%,关节镜-0.84N·m/BW·HT[%][0.06-1.61]%;上升:PHT-0.464N·m/BW·HT[%][-0.002至0.93]%,关节镜-0.90N·m/BW·HT[%][0.13-1.67]%)。
■探索性数据表明,在12个月的随访中,PHT或髋关节镜检查在引起躯干变化方面均不优越,骨盆,或下肢生物力学。两种治疗方法都可能引起运动学和力矩的变化,然而,这些变化的影响是未知的。
■澳大利亚新西兰临床试验注册中心参考:ACTRN12615001177549。审判登记2015年2月11日。
UNASSIGNED: Femoroacetabular impingement syndrome (FAIS) can cause hip pain and chondrolabral damage that may be managed non-operatively or surgically. Squatting motions require large degrees of hip flexion and underpin many daily and sporting tasks but may cause hip impingement and provoke pain. Differential effects of physiotherapist-led care and arthroscopy on biomechanics during squatting have not been examined previously. This study explored differences in 12-month changes in kinematics and moments during squatting between patients with FAIS treated with a physiotherapist-led intervention (Personalised Hip Therapy, PHT) and arthroscopy.
UNASSIGNED: A subsample (n = 36) of participants with FAIS enrolled in a multi-centre, pragmatic, two-arm superiority randomised controlled trial underwent three-dimensional motion analysis during squatting at baseline and 12-months following random allocation to PHT (n = 17) or arthroscopy (n = 19). Changes in time-series and peak trunk, pelvis, and hip biomechanics, and squat velocity and maximum depth were explored between treatment groups.
UNASSIGNED: No significant differences in 12-month changes were detected between PHT and arthroscopy groups. Compared to baseline, the arthroscopy group squatted slower at follow-up (descent: mean difference -0.04 m∙s-1 (95%CI [-0.09 to 0.01]); ascent: -0.05 m∙s-1 [-0.11 to 0.01]%). No differences in squat depth were detected between or within groups. After adjusting for speed, trunk flexion was greater in both treatment groups at follow-up compared to baseline (descent: PHT 7.50° [-14.02 to -0.98]%; ascent: PHT 7.29° [-14.69 to 0.12]%, arthroscopy 16.32° [-32.95 to 0.30]%). Compared to baseline, both treatment groups exhibited reduced anterior pelvic tilt (descent: PHT 8.30° [0.21-16.39]%, arthroscopy -10.95° [-5.54 to 16.34]%; ascent: PHT -7.98° [-0.38 to 16.35]%, arthroscopy -10.82° [3.82-17.81]%), hip flexion (descent: PHT -11.86° [1.67-22.05]%, arthroscopy -16.78° [8.55-22.01]%; ascent: PHT -12.86° [1.30-24.42]%, arthroscopy -16.53° [6.72-26.35]%), and knee flexion (descent: PHT -6.62° [0.56- 12.67]%; ascent: PHT -8.24° [2.38-14.10]%, arthroscopy -8.00° [-0.02 to 16.03]%). Compared to baseline, the PHT group exhibited more plantarflexion during squat ascent at follow-up (-3.58° [-0.12 to 7.29]%). Compared to baseline, both groups exhibited lower external hip flexion moments at follow-up (descent: PHT -0.55 N∙m/BW∙HT[%] [0.05-1.05]%, arthroscopy -0.84 N∙m/BW∙HT[%] [0.06-1.61]%; ascent: PHT -0.464 N∙m/BW∙HT[%] [-0.002 to 0.93]%, arthroscopy -0.90 N∙m/BW∙HT[%] [0.13-1.67]%).
UNASSIGNED: Exploratory data suggest at 12-months follow-up, neither PHT or hip arthroscopy are superior at eliciting changes in trunk, pelvis, or lower-limb biomechanics. Both treatments may induce changes in kinematics and moments, however the implications of these changes are unknown.
UNASSIGNED: Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015.