Altered biomechanical stimulation of the developing hip joint in presence of hip dysplasia risk factors

JOURNAL OF BIOMECHANICS

卷:78

Article

Verbruggen, Stefaan W.¹  Kainz, Bernhard²  Shelmerdine, Susan C.³  Arthurs, Owen J.^3,4  Hajnal, Joseph V.⁵  Rutherford, Mary A.^7,6  Phillips, Andrew T. M.⁸  Nowlan, Niamh C.¹ 

[1] Imperial Coll London, Dept Bioengn, London SW7 2AZ, England

[2] Imperial Coll London, Dept Comp, London, England

[3] Great Ormond St Hosp Sick Children, Dept Radiol, London, England

[4] UCL Great Ormond St Inst Child Hlth, London, England

[5] Kings Coll London, Sch Biomed Engn & Imaging Sci, Dept Biomed Engn, London, England

[6] Kings Coll London, Sch Biomed Engn & Imaging Sci, Ctr Developing Brain, London, England

[7] Kings Coll London, Sch Biomed Engn & Imaging Sci, Dept Perinatal Imaging & Hlth, London, England

[8] Imperial Coll London, Dept Civil & Environm Engn, London, England

关键词: Musculoskeletal development;    Joint biomechanics;    Cine MRI;    Developmental dysplasia of the hip;    Computational model;    External cephalic version;    ECV;   

DOI  :  10.1016/j.jbiomech.2018.07.016

来源: Elsevier

【 摘 要 】

Fetal kicking and movements generate biomechanical stimulation in the fetal skeleton, which is important for prenatal musculoskeletal development, particularly joint shape. Developmental dysplasia of the hip (DDH) is the most common joint shape abnormality at birth, with many risk factors for the condition being associated with restricted fetal movement. In this study, we investigate the biomechanics of fetal movements in such situations, namely fetal breech position, oligohydramnios and primiparity (firstborn pregnancy). We also investigate twin pregnancies, which are not at greater risk of DDH incidence, despite the more restricted intra-uterine environment. We track fetal movements for each of these situations using cine-MRI technology, quantify the kick and muscle forces, and characterise the resulting stress and strain in the hip joint, testing the hypothesis that altered biomechanical stimuli may explain the link between certain intra-uterine conditions and risk of DDH. Kick force, stress and strain were found to be significantly lower in cases of breech position and oligohydramnios. Similarly, firstborn fetuses were found to generate significantly lower kick forces than non-firstborns. Interestingly, no significant difference was observed in twins compared to singletons. This research represents the first evidence of a link between the biomechanics of fetal movements and the risk of DDH, potentially informing the development of future preventative measures and enhanced diagnosis. Our results emphasise the importance of ultrasound screening for breech position and oligohydramnios, particularly later in pregnancy, and suggest that earlier intervention to correct breech position through external cephalic version could reduce the risk of hip dysplasia. (C) 2018 The Authors. Published by Elsevier Ltd.

【 授权许可】

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