Osteotomy of the greater trochanter: effect on gluteus medius function

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• 作者：Martin Beck ; A. Krüger ; C. Katthagen ; S. Kohl
• 关键词：Abductor function ; Osteotomy greater trochanter ; Muscle function ; Hip
• 刊名：Surgical and Radiologic Anatomy
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：37
• 期：6
• 页码：599-607
• 全文大小：1,778 KB
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• 作者单位：Martin Beck (1) (2)
  A. Krüger (2)
  C. Katthagen (3)
  S. Kohl (2)
  
  1. Clinic for Orthopedic and Trauma Surgery, Luzerner Kantonsspital, 6004, Lucerne, Switzerland
  2. Department of Orthopedic Surgery, University of Bern, Inselspital, 3010, Bern, Switzerland
  3. Department of Trauma and Reconstructive Surgery, Diakoniekrankenhaus Friederikenstift GmbH, 30169, Hannover, Germany
  
• 刊物主题：Imaging / Radiology; Orthopedics; Anatomy;
• 出版者：Springer Paris
• ISSN：1279-8517

文摘

Purpose Advancement of the greater trochanter alters the function of the gluteus medius muscle. However, with the exception of clinical studies and biomechanical lever arm studies, no publications that analyze the consequences of advancement of the greater trochanter on the muscle function exist. The aim of the study was to analyze the mechanical changes of gluteus medius after osteotomy of the greater trochanter in a lab setting. Methods An anatomical study of origin and insertion of the gluteus medius was carried out on four hips. Based on the dissections, a string model was developed dividing the muscle into five sectors. Changes in muscle fiber length were measured for every 10° of flexion, internal and external rotation and abduction with the trochanter in anatomic, proximalized and distalized positions. Results Distalization of the trochanter leads to an imbalance of muscle action, moving the isometric sector of the muscle anteriorly with more muscle sectors being active during flexion and less during extension. Stretching of the muscle increases passive forces but decreases the force generation capacity of the muscle and at the same time increased muscle fiber excursion may require more energy consumption, which may explain earlier fatigue of the abductor musculature after distalization of the trochanter. For abduction, distalization of the muscle attachment leads to a change in contraction pattern from isometric to isotonic. Optimal balancing and excursion of the muscle is when the tip of the greater trochanter is at level with the hip rotation center. Conclusions In hips with high riding trochanter, the optimal position is at the level of the center of hip rotation. Excessive distalization should be avoided. As the conclusions and considerations are based on a lab setting, transfer to clinical practice may not necessarily apply.