Журнал «Травма» Том 16, №4, 2015
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Dynamics of biomechanical and electromiographic data in cases of deformation of the trochanter major
Авторы: Gromov, A. B., Korolkov O.I., Karpinska O.D., Isayeva N.P.
Рубрики: Травматология и ортопедия
Разделы: Клинические исследования
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The aim of the research: present the dynamics of biomechanical and electromyographic data in cases of deformation of the trochanter major during pre- and post-surgical periods.
Material and methods. The research contains the data evaluation of 70 children from 4 to 18 y.o. (6 boys and 24 girls) with the trochanter major deformation in the setting of various thigh bone pathologies, proximal femur deformation, due to the inflammatory processes of the thighbone, coxa vara, Legg-Calve-Perthes disease, who had been receiving a hospital treatment at the children unit of State health care institution of Axis and joints pathology after Prof. M.I. Sytenko. The investigation covered the period from 1998 to 2014. The mentioned methods have been used to analyze the patients data in pre- and post-surgical periods (in 5-10 years after the surgical invasion).
Obtained results and their discussion.
Static graphical research data. The patients were divided into 2 groups. The 1st group included the children, who received a surgical treatment before the age of 6, the 2nd group included the children, who undergone a surgical invasion after the age of 6. The table 1 displays the calculated ration of the children's vertical standing before and after the surgery.
The equilibration function of the patients with thigh bone femoral head deformation is corrupted, especially at preferential leaning on one limb. The abnormality remains even after the treatment. Although it should be noted, that the deviation of the body of mentioned patients at the sagittal plane while leaning on one limb is not going beyond the wobbling grade of a two-limb stand.
The most significant changes in the trochanter major component are noticed in the case of development of deformation progression of the proximal femur deformation due to inflammatory processes: at the lesion of one side of the abductor muscles, the strength of that side was reduced by 25% to 40% in comparison with the other one; the indexes of the static graphical research (the rate of weighting on the limbs, steadiness, and the percentage correlation between the on each limb and the body weight) also were notable for the high level of deviation from the norm and from the healthy limb specifically in the case of the proximal femur deformation doe to inflammatory processes.
As a result of measuring the indexes of the trochanter major of the proximal femur long after the post-surgery period (over 5 years and more) the following data, which depended on the particular qualities of the thighbone pathology, the kind of surgery invasion and the age of the patient (the average data is given below) was obtained: the abductor muscles strength grew in all the cases comparing to the initial indexes, although the grow varied in the limits of the wide range: from 5 to 20% in the case of inflammatory processes, up to 30-45% in the case of coxa vara and Legg-Calve-Perthes disease (in 15,7 cases was recorded its growth from 7% even to 26%, comparing to the other lesion); the static graphical research indexes showed the moderate deviation from the norm and from the healthy leg, but in all the cases they had a strong tendency towards the normalization of its qualities.
At the electromyographic muscles exploration at the pre- and post-surgery periods we can observe the positive tendency towards the normalization of the bioelectrical activity of the abductor muscles of the thighbone due to the reduction of the m.gluteusmedius activity and the escalation of the m. adductormagnus activity. At the process of more detailed electromyographic data analysis of the patient group with Legg-Calve-Perthes disease and congenital dislocation of the hip it becomes clear, that most of the patients have reciprocal balance disorder between the abductor muscles: the reduction of the amplitude of m. glutaeusmedius and increasing of the amplitude of m. adductormagnus of the disordered limb.
Conclusions.
1. Determined the direct relation between the severity level of anatomic functional changes (including the muscular changes) and the original pathology of the thighbone (the major changes are noticed in the cases of thighbone pathology due to the inflammatory processes (pathological thighbone dislocation) and the minor changes were revealed in the cases of Legg-Calve-Perthes disease and coxavara) and between the age of the patient when the pathology occurred: the younger the patient is the more sever the changes are.
2. The biomechanical and electromyographic surveys allow to assert that in the cases of intense trochanter major deformation the multidirectional changes in the muscles (primarily in the pelvio trochanter group) occur. So, in the case of hemilesion the abductor muscles strength of one lesion was reduced by 25% to 40% in comparison with the other one; the indexes of the static graphical research (the rate of weighting on the limbs, steadiness, and the percentage correlation between the weighting on each limb and the body weight) also were notable for the greatest deviation from the norm and from the healthy leg specifically in the case of the proximal femur deformation doe to inflammatory processes and in the case of the high positioning of the trochanter major at the Legg-Calve-Perthes disease and coxa vara - the strength lesion of one side of the abductor muscles was not as significant (in 44% of cases even revealed the increase of strength from 15% up to 36%) as that of the other side; the indexes of the electromyographic data showed the similar changes during the pre- and post-surgery periods.
3. The gathered statistics should become a reference mark for further dynamics observation. The complex clinical x-ray biomechanical and electromyographic examination of children with thigh trochanter major deformation allows to split them into different groups according to the level of anatomic functional changes and define the individual approaches of treatment (including surgical) strategies for a particular group.