Method for diagnosing frontal hip joint balance disorders

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to the intersection of two specialties: traumatology, orthopedics, and rehabilitation medicine. A method for diagnosing disorders of the frontal balance of the hip joint is proposed, including recording the patient's postures when flexing the hip joint with a television camera and storing them in a computer database, the patient performs movements three times, which are recorded using a video camera connected to a computer with the Arthro-Pro program installed, the values of angles during active flexion are selected for analysis by the program, graphs of the dynamics of angle changes during active flexion are constructed, according to which the program makes a conclusion about the presence of hip joint dysfunction, marks the hip joint points, connects them with lines, and measures the angle for the hip joint under study, characterized in that the patient is positioned with his back to the video camera and performs three Trendelenburg tests sequentially for 30 seconds on each leg without tilting the body to the sides, the results are used to compare the range of oscillations of each Trendelenburg test on each leg and diagnose frontal (coronal) balance disorders of the hip joint based on the change in the angle of oscillations between the line connecting the centers of the hip joints and the vertical line.EFFECT: invention provides an opportunity to assess frontal (coronal) balance disorders of the hip joint by analyzing the angle of oscillations between the line connecting the centers of the hip joints and the vertical line.1 cl, 1 dwg

Description

[0001] The invention relates to medicine, namely, it is at the intersection of two specialties - traumatology, orthopedics and restorative medicine.

[0002] A clinical examination of the musculoskeletal system, including the functional state of the hip joint, is known. This involves collecting anamnesis, examining, and comparing symmetrical body parts. The examination is performed with the patient in both vertical and horizontal positions, and includes gait testing, palpation, and examination of hip joint movements, as well as specific clinical tests. A quadrant test is performed as follows: the patient lies supine, the physician flexes the hip and knee joints of the limb being examined and directs it toward the opposite shoulder. The physician then moves the hip into abduction while maintaining hip flexion. The appearance of crepitus or percussion, felt by the physician, indicates the presence of hip joint pathology; with Trendelenburg's sign, hip damage is characterized by the early development of weakness of the hip abductor muscles (gluteus medius and minimus).To diagnose this condition, the patient is asked to alternately raise both legs. If the hip abductor muscles on the weight-bearing side are weak, the pelvis tilts, the patient loses balance, and is unable to support the healthy leg. The Thomas test can detect the development of compensatory lumbar lordosis in some patients, which masks the presence of hip flexion contracture, which is most common in primary and secondary osteoarthritis. The test is performed with the patient lying down. The patient is asked to flex the knee and hip joints of the healthy side, gradually bringing the leg toward the chest. If, as the hip flexion angle increases, the opposite hip also begins to flex, this indicates the presence of hip flexion contracture.The inability to firmly press the lumbar spine to the flat surface of the couch may also indicate the presence of flexion contracture of the hip joint (see Imametdinova G.R., Chichasova N.V., Nasonov E.L., Arkhipov S.V. Methods of clinical examination of the musculoskeletal system in rheumatology and rheumatoorthopedics. M., 2011).

[0003] A method for early diagnosis of hip joint dysfunction is known, in which, based on measuring the magnitude of pelvic tilt in degrees, in the frontal plane at the marked points corresponding to the posterior superior spines of the ischial bones (spina iliaca posterior superior), standing in the static initial position of the patient, and the functional tilt of the pelvis when testing in two positions, alternately standing on the left and right leg, with flexion of the contralateral leg at the hip and knee joints at an angle of 90 °, the Δ-delta values ​​​​are calculated using the formulas Δs = SM for the test on the left leg, Δd = MD for the test on the right leg, where M is the magnitude of pelvic tilt in the initial position of the patient, S and D are the values ​​​​of the functional tilt of the pelvis when standing on the left and right legs, respectively, normally, the values ​​​​of Δs and Δd have a positive value of 2 ° and more and the difference in values ​​between Δs and Δd does not exceed 2°;in case of pathology on both sides, the values ​​Δs and Δd have a negative value; in case of unilateral pathology, one of the values ​​Δs or Δd has a negative value or the difference between the values ​​Δs and Δd exceeds 2°, regardless of the sign of the A-delta. Russian Federation Patent No. 2324446, published on 20.05.2008).

[0004] A method for diagnosing functional disorders of the lumbosacral spine is known, characterized by the fact that initially, in the initial data module, a database of images of the standard performance of diagnostic exercises, functional diagnostics of disorders of the lumbosacral spine, is formed, after which stages of collecting the anamnesis of the person's life, anamnesis of the disease, functional and software diagnostics of the lumbosacral spine are carried out, with the formation of a list of kinesitherapeutic and rehabilitation exercises for the correction and treatment of the identified functional disorders of the lumbosacral spine of the patient, while at the stage of software diagnostics of the state of the lumbosacral spine, images of the patient performing a set of diagnostic exercises are obtained, according to which, using machine vision technology, a three-dimensional model of the patient is constructed in the frame,including the designation of the location of the lumbosacral spine on the image of the patient's musculoskeletal system in the form of a reference point on his skeletal model, wherein the reference points on the skeletal model include: nose; inner corner of the left eye; center of the left eye; outer corner of the left eye; inner corner of the right eye; center of the right eye; outer corner of the right eye; left ear; right ear; left corner of the mouth; right corner of the mouth; left shoulder; right shoulder; left elbow; right elbow; left wrist; right wrist; little finger of the left hand; little finger of the right hand; index finger of the left hand; index finger of the right hand; thumb of the left hand; thumb of the right hand; left thigh; right thigh; left knee; right knee; left ankle; right ankle; left heel; right heel; index toe of the left foot; index finger of the right foot; central vertical axis,in this case, an assessment is made of the spatial position of the specified point of the lumbosacral spine by determining the angular deviations of the patient's lumbosacral spine relative to the support points of the right and left hip joint, the right and left shoulder joint, as well as relative to the central vertical axis of the patient's lumbosacral spine, after which the obtained values ​​​​are compared with the values ​​​​of the opening angles and degrees of freedom of the hip joint specified in the atlas of reference values, where at 0-14.9% deviation the norm is diagnosed; at 15-24,A 9% deviation is considered to be below the norm; a 25-50% deviation is considered to be a non-critical disease; a deviation of over 50% is considered to be a serious disease and a recommendation is given to consult a doctor without the use of kinesiotherapeutic and rehabilitation exercises for functional disorders of the hip joint; and based on the deviations obtained, a list of kinesiotherapeutic and rehabilitation exercises is compiled on the basis of the created database to correct and treat the identified functional disorders of the patient's lumbosacral spine. The set of diagnostic exercises for the functional diagnosis of disorders of the lumbosacral spine includes the following exercises:

[0005] - the patient lies on his back with his side to the video camera, legs together, extended, bending the left leg at the knee, pulls it to the chest, takes hold of the foot or ankle with his right hand and straightens the leg as much as possible to the face, lowers the leg back, then bending the right leg at the knee, pulls it to the chest, takes hold of the foot or ankle with his left hand and straightens the leg as much as possible to the face, lowers the leg back;

[0006] - the patient sits on the floor sideways to the video camera, legs together, extended, bends forward towards the legs until the toes are touched with the hands, straightens back up;

[0007] - the patient stands directly in front of the video camera, feet shoulder-width apart, bends down as far as possible with his hands to the floor, without bending his knees, straightens back up;

[0008] - the patient stands sideways to the video camera, leans forward and touches the floor with his hands, straightens back up;

[0009] - the patient sits on a chair sideways to the video camera, holding this position for 3 seconds, then sits on the edge of the chair sideways to the video camera, leans forward, touching the floor with his hands, and straightens back up;

[0010] - The patient stands directly in front of the camera, feet shoulder-width apart, leans as far to the left as possible without leaning the body forward, reaches the left hand to the knee, straightens back up, and similarly leans as far to the right as possible, reaches the right hand to the knee, and straightens back up. (RU Patent No. 2825058, published August 19, 2024).

[0011] A method for assessing the functional state of the hip joint has been selected as a prototype, including recording the patient's postures during hip flexion with a television camera and storing them in a computer database, while assessing the patient's ability to perform active movements, for which the patient, lying on a couch, makes at least three movements that are recorded using a video camera connected to a computer with the Arthro-Pro program installed and located sagittally relative to the patient, and said movements contain stages in which: each time, the patient first actively flexes the hip joint of one of the legs to the maximum possible with the other leg fixed with a belt to the couch, and then performs further passive flexion with the help of his own hands to the maximum possible, while the maximum values ​​​​of the flexion angles during active and passive flexion are selected for analysis by the program,and also graphs of the dynamics of the change in the angle of flexion during active and passive flexion are constructed, based on which the program draws a conclusion about the degree of flexion contracture and the presence of dysfunction of the hip joint, while marking the points of the shoulder, hip, knee and ankle joints, connecting them with lines, and measuring for the hip joint under study the angle between the line connecting the points in the shoulder, hip joints, and the line connecting the points in the hip and knee joints, during the active and passive performance of the diagnostic exercise, and the assessment of the patient's ability to perform movements is performed for each of the legs separately. (Patent of the Russian Federation No. 2846347, published 04.09.2025).,

[0012] The general disadvantages of known methods include their use for a static position of the spine, without taking into account the state of the musculoskeletal system in dynamics, as well as the inability to assess disturbances in the frontal (coronary) balance of the hip joint.

[0013] The task is to develop a method for visual diagnostics of frontal (coronary) balance disorders of the hip joint.

[0014] The technical result is the ability to assess frontal balance disorders of the hip joint through the analysis of the oscillation angle formed between the line connecting the centers of the hip joints and the plumb line.

[0015] The technical result is achieved by a method for diagnosing frontal balance disorders of the hip joint, including recording the patient's postures during hip flexion with a television camera and storing them in a computer database, the patient makes movements three times, which are recorded using a video camera connected to a computer with the Arthro-Pro program installed, the program selects the angle values ​​​​during active flexion for analysis, plots the dynamics of the angle change during active flexion, based on which the program concludes on the presence of dysfunction of the hip joint, mark the points of the hip joint, connect them with lines, measure the angle for the hip joint under study, while the patient is positioned with his back to the video camera and sequentially performs three Trendelenburg tests for 30 seconds on each leg without deviating the body to the sides,Based on the obtained results, the range of oscillations of each Trendelenburg test on each leg is compared and disturbances in the frontal (coronal) balance of the hip joint are diagnosed by the change in the angle of oscillation between the line connecting the centers of the hip joints and the plumb line.

[0016] According to the classic Trendelenburg test, when the patient stands on the affected leg on the opposite side, the pelvis should drop due to the weakness of the gluteal muscles.

[0017] The oscillation range is known and its deviation to the right or left is determined by the value 5.6°. (According to Moharrami A, Mirghaderi P, Hoseini Zare N, Moazen-Jamshidi MM, Ebrahimian M, Mortazavi SMJ. Slight pelvic obliquity is normal in a healthy population: a cross-sectional study. J Exp Orthop. 2023 May 31; 10(1):57. doi: 10.1186 / s40634-023-00613-z. PMID: 37254005; PMCID: PMC10229507.) From zero, the deviation angle can be both +5.6° and -5.6°, while the total deviation range can be 11.2°, which is the norm in the diagnosis of frontal (coronal) balance disorders of the hip joint. If the fluctuations exceed 11.2°, then this is considered a deviation from the normal values.

[0018] When conducting research among patients who had quite painful areas of the hip joints, it was found that when conducting the Trendelenburg test, the pelvis rose in some patients, while in other patients it fell.

[0019] This can be explained by the fact that, against the background of pain, muscles can not only weaken, become exhausted and atrophy, but also contract in the form of a muscle spasm, and due to this, the pelvis will rise on the opposite side.

[0020] Depending on the range of oscillations, there may be variations in the disruption of the frontal (coronary) balance of the spinal-pelvic complex:

[0021] - pelvic tilt to the right - with an oscillation range greater than 5.6 (i.e. lowering of the right side of the pelvis, while the oscillation angle values ​​become less than 84.4°);

[0022] -pelvic tilt to the left - with a range of oscillations greater than 5.6° (i.e. when the left side of the pelvis is lowered, the oscillation values ​​become greater than 95.6°).

[0023] The Trendelenburg test is performed by asking the subject to stand on one leg for 30 seconds without leaning to the side. During the test, the sway angle between the line connecting the hip joint centers and a plumb line is recorded, and a graph is plotted showing the range of sway angle variation.

[0024] When using the declared method, the following technical means are used: a computer with the Arthro-Pro program installed (registration certificate No. 2023667718) and a video camera.

[0025] This method allows you to quickly diagnose frontal balance disorders of the hip joint.

[0026] When each of the three Trendelenburg tests is performed on a patient, data is collected on the variation in the angle between the line connecting the centers of the hip joints and the plumb line for each leg.

[0027] Plumb line is a line running from the tip of the spinous process of the cervical vertebra to the floor.

[0028] The invention is schematically explained by a figure showing a line connecting the centers of the hip joints 1, a plumb line 2 and an angle of oscillation between lines a.

[0029] Diagnostics are carried out as follows:

[0030] When using the Arthro-Pro program, the patient is videotaped while performing the Trendelenburg maneuver. The patient is positioned with their back to the camera. The maneuver is performed three times on each leg for 30 seconds.

[0031] The program then converts the digital values ​​into a graph—a goniogram. The program plots points, measures angles, and creates graphs—goniograms—that the physician uses to compare the dynamics of the angle fluctuations between the line connecting the hip joint centers and the plumb line.

[0032] Confirmation of a negative Trendelenburg test result is the absence or change of the angle between the line connecting the hip joint centers and the plumb line within 11.2°. Confirmation of a positive Trendelenburg test result is a lowering or rising of the pelvis on the opposite side exceeding 11.2°.

[0033] An example of a clinical case.

[0034] Patient M., 60 years old, BMI 29 kg / m 2 She has been suffering from stage I osteoarthritis of the left hip (according to Kosinskaya) for 5 years. Exacerbations are managed with nonsteroidal anti-inflammatory drugs. She returned to see an orthopedic traumatologist complaining of pain in her left hip.

[0035] Clinical examination revealed pain in the periarticular tissues of the left lumbosacral spine and left gluteal region; range of motion in the joint is not limited.

[0036] Visual diagnostics was performed to assess the frontal balance disorders of the hip joint.

[0037] The patient was positioned with his back to the video camera and sequentially performed three Trendelenburg tests on each leg for 30 seconds without deviating the body to the sides.

[0038] The Arthro-Pro program was used for video recording on a video camera.

[0039] Then the program plotted the points, measured the angles and converted the digital values ​​into a graph - a goniogram.

[0040] Based on the obtained results, the dynamics of the sway angle of each leg, formed between the line connecting the centers of the hip joints and the vertical line, were compared. The sway angle exceeded 11.2° with a rightward tilt, indicating functional shortening of the left gluteus medius and quadratus medius muscles due to spasm due to pain.

[0041] Thus, the claimed method for diagnosing frontal balance disorders of the hip joint provides the ability to assess frontal balance disorders of the hip joint through the analysis of the oscillation angle formed between the line connecting the centers of the hip joints and the plumb line.

Claims

The invention relates to medicine, namely, it is at the intersection of two specialties - traumatology, orthopedics and restorative medicine. A method for diagnosing frontal balance disorders of the hip joint is proposed, including recording the patient's postures during hip flexion with a television camera and storing them in a computer database. The patient makes three movements that are recorded using a video camera connected to a computer with the Arthro-Pro program installed. The program selects the angle values ​​​​during active flexion for analysis, plots the dynamics of the angle change during active flexion, based on which the program concludes the presence of hip joint dysfunction, marks the points of the hip joint, connects them with lines, measures the angle for the hip joint under study, characterized in that,The patient is positioned with his back to the video camera and sequentially performs three Trendelenburg tests for 30 seconds on each leg without tilting the body to the side. Based on the results obtained, the range of oscillations of each Trendelenburg test on each leg is compared, and frontal (coronal) balance disorders of the hip joint are diagnosed based on the change in the angle of oscillation between the line connecting the centers of the hip joints and the plumb line. The invention makes it possible to assess frontal (coronal) balance disorders of the hip joint by analyzing the angle of oscillation formed between the line connecting the centers of the hip joints and the plumb line. 1 fig.,

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