Rehabilitation for patients with developmental dysplasia of the hip (DDH) addresses modifiable factors in an effort to reduce symptoms and prevent or delay the development of osteoarthritis, yet its effect on joint mechanics remains unknown. Our objective was to establish how rehabilitation (muscle strengthening and movement training), simulated with a musculoskeletal model and probabilistic analyses, alters hip joint reaction forces (JRF) in patients with DDH during a single limb squat. In four patients with DDH, hip abductor strengthening was simulated by increasing the maximum isometric force value between 0 and 32.6% and movement training was simulated by decreasing the hip adduction angle between 0 and 10° relative to baseline. 2,000 Monte Carlo simulations were performed separately to simulate strengthening and movement training, from which 99% confidence bounds and sensitivity factors were calculated. Our results indicated that simulated movement training aimed at decreasing hip adduction had a substantially larger influence on hip JRF than strengthening, as indicated by 99% confidence bounds of the resultant JRF (0.88 ± 0.55 xBW vs. 0.31 ± 0.12 xBW, respectively). Relative to baseline, movement training that resulted in a 10° decrease in hip adduction decreased the resultant JRF by 0.78 ± 0.65 xBW, while strengthening the abductors by 17.6% increased resultant JRF by 0.18 ± 0.06 xBW. To our knowledge, these results are the first to provide evidence pertaining to the effect of rehabilitation on joint mechanics in patients with DDH and can be used to inform more targeted interventions.

发育性髋关节发育不良 (DDH) 患者的康复治疗可以解决可改变的因素，以减轻症状并预防或延缓骨关节炎的发展，但其对关节力学的影响仍不清楚。我们的目标是确定通过肌肉骨骼模型和概率分析模拟的康复（肌肉强化和运动训练）如何改变 DDH 患者在单肢深蹲期间的髋关节反作用力 (JRF)。在四名 DDH 患者中，通过将最大等长力值增加到 0 到 32.6% 来模拟髋关节外展肌强化，并通过相对于基线将髋关节内收角减小到 0 到 10° 来模拟运动训练。分别进行了 2,000 次蒙特卡罗模拟来模拟强化和运动训练，从中计算出 99% 的置信界限和敏感度因子。我们的结果表明，旨在减少髋部内收的模拟运动训练对髋部 JRF 的影响远大于强化训练，如所得 JRF 的 99% 置信区间所示（分别为 0.88 ± 0.55 xBW 与 0.31 ± 0.12 xBW）。相对于基线，导致髋部内收减少 10° 的运动训练使所得 JRF 降低了 0.78 ± 0.65 xBW，而加强外展肌 17.6% 则使所得 JRF 提高了 0.18 ± 0.06 xBW。据我们所知，这些结果首次提供了有关康复对 DDH 患者关节力学影响的证据，可用于为更有针对性的干预措施提供信息。