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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 164 -173. doi: 10.3877/cma.j.issn.1674-134X.2026.02.005

临床论著

单侧全髋关节置换术前髋周肌群质量与术后功能的相关性
鲍正远1, 蔡宖钢1, 崔灿2, 张颖恺2, 蒋青1, 徐志宏1,†()   
  1. 1　210008，南京大学医学院附属鼓楼医院运动医学与成人重建外科
    2　香港中文大学矫形及创伤学系
  • 收稿日期:2025-11-23 出版日期:2026-04-01
  • 通信作者: 徐志宏
  • 基金资助:
    南京市国际/港澳台联合研发项目(202308002); 南京鼓楼医院青年培育项目专项资金(2025-JCYJ-QP-079)

Association of preoperative hip muscle quality with functional outcomes after total hip arthroplasty

Zhengyuan Bao1, Hung-Kang Tsai1, Can Cui2, Wing-Hoi Cheung2, Qing Jiang1, Zhihong Xu1,†()   

  1. 1 Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
    2 Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
  • Received:2025-11-23 Published:2026-04-01
  • Corresponding author: Zhihong Xu
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引用本文：

鲍正远, 蔡宖钢, 崔灿, 张颖恺, 蒋青, 徐志宏. 单侧全髋关节置换术前髋周肌群质量与术后功能的相关性[J/OL]. 中华关节外科杂志(电子版), 2026, 20(02): 164-173.

Zhengyuan Bao, Hung-Kang Tsai, Can Cui, Wing-Hoi Cheung, Qing Jiang, Zhihong Xu. Association of preoperative hip muscle quality with functional outcomes after total hip arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 164-173.

目的

比较单侧全髋关节置换术（THA）患者术前两侧髋周肌群质量，并探究其与术后行走及坐-立功能的相关性。

方法

该回顾性研究纳入了2022年1月至2023年12月因股骨头无菌性坏死或髋骨性关节炎行单侧初次THA的305名患者。排除标准包括长期卧床病史，术侧髋关节有手术史，髋关节发育不良，术后出现严重并发症以及影像或功能评估数据不全。最终133名患者纳入本研究。通过术前CT测量双侧髋周肌群的总肌肉面积指数（TMI）、正常衰减肌肉面积指数（NAMI）和脂肪浸润（FI）。在术后3个月进行5次坐立和6 m行走测试。采用配对t检验或Wilcoxon秩和检验比较双侧肌肉成分。将Pearson相关因素计算中P<0.1的因素纳入进行多元线性回归分析。

结果

对侧臀大肌（t=-10.700，P<0.001）、臀中肌（Z=-3.407，P=0.001）、髂腰肌（t=-6.839，P<0.001）和股直肌（t=-6.327，P<0.001）TMI值显著高于术侧。对侧臀大肌（NAMI：t=-12.359，P<0.001；FI：Z =-8.774，P<0.001）、臀中肌（NAMI：t=-8.213，P<0.001；FI：Z =-8.241，P<0.001）、臀小肌（NAMI：t=-5.110，P<0.001；FI：Z =-7.063，P<0.001）、髂腰肌（NAMI：t=-9.010，P<0.001；FI：Z =-7.587，P<0.001）、梨状肌（NAMI：Z =-5.841，P<0.001；FI：Z=-6.569，P<0.001）和股直肌（NAMI：t=-6.835，P<0.001；FI：Z =-4.500，P<0.001）表现出显著更高的NAMI和更低FI值。多元线性回归分析中，年龄（B=0.123，P<0.001）和对侧臀小肌FI（B=5.948，P=0.013）与5次坐立时间独立正相关，对侧臀大肌TMI（B=-0.438，P=0.001）与5次坐立时间独立负相关。年龄（B=-0.006，P<0.001）和对侧髂腰肌FI（B=-1.178，P<0.001）与6 m行走步速独立负相关，对侧臀小肌TMI（B=0.047，P=0.025）与6 m行走步速独立正相关。

结论

单侧THA术前非手术侧的臀大肌、臀小肌和髂腰肌的肌肉状况与术后3个月的行走和坐立能力显著相关。

关键词: 髋关节, 肌肉萎缩, 关节成形术, 置换, 髋, 康复
Objective

To identify preoperative muscle compositions of operated and contralateral sides and examine the association with postoperative walking and chair-raising outcomes after unilateral total hip arthroplasty (THA).

Methods

This retrospective study included 305 patients who underwent unilateral primary THA due to femoral head necrosis or hip osteoarthritis from January 2022 to December 2023. Exclusion criteria were: a history of long-term bedridden, prior hip surgery history on the operative side, hip dysplasia, severe complications after THA, incomplete imaging or functional data. A total of 133 patients were included in this study. Bilateral total muscle area index (TMI), normal attenuation muscle area index (NAMI) and fat infiltration (FI) of hip muscles were examined on a preoperative axial CT image. Six-meter walking test (6mWT) and five times sit-to-stand test (5-STST) were conducted at three-month follow-up. Paired t test or Wilcoxon rank sum test were used to compare the differences between bilateral muscle compositions. Pearson correlation coefficients were calculated to determine the factors associated with 6mWT and 5-STST results. Factors with P<0.1 in the univariate analysis were included in multivariate linear regression analysis.

Results

Preoperatively, TMI was significantly higher on the contralateral side of gluteus maximus (t=-10.700, P<0.001), gluteus medius (Z=-3.407, P=0.001), iliopsoas (t=-6.839, P<0.001), and rectus femoris (t=-6.327, P<0.001) compared with the operative side. In terms of muscle quality, NAMI was significantly higher and FI was significantly lower on the contralateral side of gluteus maximus (NAMI: t=-12.359, P<0.001, FI: Z=-8.774, P<0.001), gluteus medius (NAMI: t=-8.213, P<0.001, FI: Z=-8.241, P<0.001), gluteus minimus (NAMI: t=-5.110, P<0.001, FI: Z=-7.063, P<0.001), iliopsoas (NAMI: t=-9.010, P<0.001, FI: Z=-7.587, P<0.001), piriformis (NAMI: Z=-5.841, P<0.001, FI: Z=-6.569, P<0.001), and rectus femoris (NAMI: t=-6.835, P<0.001, FI: Z=-4.500, P<0.001) compared with the operative side. In multivariate regression analysis, age (B=0.123, P<0.001) and contralateral gluteus minimus FI (B=5.948, P=0.013) were independently positively associated with 5-STST time. Contralateral gluteus maximus TMI (B=-0.438, P=0.001) was independently negatively associated with 5-STST time. Age (B=-0.006, P<0.001) and contralateral iliopsoas FI (B=-1.178, P<0.001) were independently negatively associated with 6mWT speed. Contralateral gluteus minimus TMI (B=0.047, P=0.025) was independently positively associated with 6mWT speed.

Conclusion

The preoperative muscle qualities of gluteus maximus, gluteus minimus and iliopsoas on the non-operative side were significantly associated with postoperative gait and sit-to-stand abilities at the three-month follow-up.

Key words: Hip joint, Muscular atrophy, Arthroplasty, replacement, hip, Rehabilitation
图1 术后骨盆X线正位片中双下肢长度、髋臼偏心距和股骨偏心距差异测量示意图 注：距离A是术侧小转子尖端到双侧泪滴连线的垂直距离，在对侧使用同样方法测量距离a，两者差值即双下肢长度差异；距离B是术侧股骨头旋转中心到双侧泪滴连线的术侧垂线的垂直距离，在对侧使用同样方法测量距离b，两者差值即髋臼偏心距差异；距离C是术侧股骨头旋转中心到股骨近端解剖轴的垂直距离，在对侧使用同样方法测量距离c，两者差值即股骨偏心距差异
Figure 1 Diagram of the postoperative discrepancy of leg length, acetabular offset and femoral offset on the anteroposterior pelvic image Note: distance A is measured as the perpendicular distance from the most medial tip of the lesser trochanter to the trans-teardrop line on the operative side, while distance a is measured using the same method on the contralateral side, the difference between them is defined as length difference of bilateral lower limbs; acetabular offset B was measured as the perpendicular distance from the femoral head rotation center to the vertical trans-teardrop line on the operative side, while distance b is measured using the same method on the contralateral side, the difference between them is defined as difference in acetabular offset ; femoral offset C on the operative side is defined as the distance from the femoral head rotation center to the anatomic axis of the proximal femur, while distance c is measured using the same method on the contralateral side, the difference between them is defined as difference in femoral offset
图2 通过术前骨盆横断面CT绘制双侧臀大肌、臀中肌、臀小肌、髂腰肌、梨状肌和股直肌的肌肉成分图。图A~B为髂前下棘水平的臀大肌，臀中肌，臀小肌，髂腰肌和梨状肌；图C~D为小转子水平的股直肌 注：绿色为正常衰减肌肉区域，蓝色为低衰减肌肉区域，紫色为肌内脂肪区域
Figure 2 Muscle quality map of bilateral gluteus maximus, gluteus medius, gluteus minimus, iliopsoas, piriformis and rectus femoris muscles on the preoperative axial CT image of pelvis. A and B are gluteus maximus, gluteus medius, gluteus minimus, iliopsoas, and piriformis at the level of the anterior inferior spine; C and D are rectus femoris at the level of the lesser trochanter Note: green is normal attenuation muscle area; blue is low attenuation muscle area; purple is intramuscular adipose area
表1 术前双侧臀周肌群肌肉质量比较
Table 1 Muscle quality comparisons between the operative and contralateral sides before surgery
参数
Parameters		 术侧
Operative side		 对侧
Contralateral side		 统计值
Statistical values		 P值
臀大肌
Gluteus maximus		 TMI ［cm2/m2，（
±s）］		 11.2±2.9 13.7±3.2 t=-10.700 <0.001
NAMI ［cm2/m2，（
±s）］		 5.9±3.3 9.4±3.7 t=-12.359 <0.001
FI ［%，M（P25，P75）］ 46.9（30.5，66.7） 28.5（18.2，44.1） Z=-8.774 <0.001
臀中肌
Gluteus medius		 TMI ［cm2/m2，M（P25，P75）］ 7.0（5.6，8.2） 7.3（6.2，8.8） Z=-3.407 0.001
NAMI ［cm2/m2，（
±s）］		 4.6±2.0 6.1±2.0 t=-8.213 <0.001
FI ［%，M（P25，P75）］ 34.3（21.1，45.9） 17.5（11.7，26.7） z=-8.241 <0.001
臀小肌
Gluteus minimus		 TMI ［cm2/m2，（
±s）］		 4.6±1.3 4.6±1.0 t=-0.066 >0.05
NAMI ［cm2/m2，（
±s）］		 3.0±1.3 3.7±1.2 t=-5.110 <0.001
FI ［%，M（P25，P75）］ 30.1（20.3，45.5） 15.5（9.9，27.8） Z=-7.063 <0.001
髂腰肌
Iliopsoas		 TMI ［cm2/m2，（
±s）］		 3.1±0.8 3.5±0.9 t=-6.839 <0.001
NAMI ［cm2/m2，（
±s）］		 2.6±0.9 3.3±0.9 t=-9.010 <0.001
FI ［%，M（P25，P75）］ 12.8（7.7，20.1） 7.1（3.9，12.0） Z=-7.587 <0.001
梨状肌
Piriformis		 TMI ［cm2/m2，M（P25，P75）］ 2.8（2.1，3.5） 2.9（2.2，3.9） Z=-1.559 >0.05
NAMI ［cm2/m2，M（P25，P75）］ 1.3（0.5，2.3） 1.7（0.8，3.1） Z=-5.841 <0.001
FI ［%，M（P25，P75）］ 55.8（33.1，77.6） 39.0（21.3，62.9） Z=-6.569 <0.001
股直肌
Rectus femoris		 TMI ［cm2/m2，（
±s）］		 1.9±0.6 2.1±0.6 t=-6.327 <0.001
NAMI ［cm2/m2，（
±s）］		 1.7±0.6 2.0±0.6 t=-6.835 <0.001
FI ［%，M（P25，P75）］ 6.7（3.5，14.3） 4.2（2.1，6.6） Z=-4.500 <0.001
表2 术后5次坐立时间和6 m行走步速的单变量分析
Table 2 Univariate analysis on time of five times sit-to-stand test and six-meter walking speed after surgery
变量
Variations		 5次坐立时间
Five times sit-to-stand time		 6 m行走步速
Six-meter walking speed
r值 P值 r值 P值
年龄Age 0.295 0.001 -0.287 0.001
性别Gender 0.083 >0.05 -0.149 >0.05
身体质量指数
Body mass index		 -0.101 >0.05 0.008 >0.05
下肢长度差异
Limb length discrepancy		 0.064 >0.05 -0.008 >0.05
髋臼偏心距差异
Acetabular offset discrepancy		 -0.050 >0.05 0.043 >0.05
股骨偏心距差异
Femoral offset discrepancy		 0.084 >0.05 0.002 >0.05
术侧
Operative side
臀大肌
Gluteus maximus		 TMI -0.022 >0.05 -0.169 >0.05
NAMI 0.029 >0.05 -0.057 >0.05
FI -0.033 >0.05 -0.033 >0.05
臀中肌
Gluteus medius		 TMI 0.002 >0.05 -0.008 >0.05
NAMI 0.028 >0.05 0.003 >0.05
FI -0.016 >0.05 -0.037 >0.05
臀小肌
Gluteus minimus		 TMI -0.036 >0.05 -0.007 >0.05
NAMI -0.046 >0.05 0.016 >0.05
FI 0.019 >0.05 -0.003 >0.05
髂腰肌
Iliopsoas		 TMI -0.008 >0.05 0.059 >0.05
NAMI -0.060 >0.05 0.146 >0.05
FI 0.103 >0.05 -0.195 0.024
梨状肌
Piriformis		 TMI -0.003 >0.05 0.076 >0.05
NAMI 0.012 >0.05 0.153 >0.05
FI -0.066 >0.05 -0.138 >0.05
股直肌
Rectus femoris		 TMI -0.268 0.008 0.228 0.024
NAMI -0.265 0.008 0.233 0.021
FI 0.106 >0.05 -0.107 >0.05
对侧
Contralateral side
臀大肌
Gluteus maximus		 TMI -0.310 <0.001 0.156 >0.05
NAMI -0.315 <0.001 0.257 0.003
FI 0.173 0.046 -0.223 0.010
臀中肌
Gluteus medius		 TMI -0.001 >0.05 0.006 >0.05
NAMI -0.097 >0.05 0.085 >0.05
FI 0.188 0.030 -0.173 0.047
臀小肌
Gluteus minimus		 TMI -0.193 0.026 0.180 0.038
NAMI -0.326 <0.001 0.286 0.001
FI 0.328 <0.001 -0.276 0.001
髂腰肌
Iliopsoas		 TMI -0.163 >0.05 0.097 >0.05
NAMI -0.207 0.017 0.177 0.041
FI 0.213 0.014 -0.336 <0.001
梨状肌
Piriformis		 TMI -0.103 >0.05 0.062 >0.05
NAMI -0.109 >0.05 0.093 >0.05
FI 0.063 >0.05 -0.125 >0.05
股直肌
Rectus femoris		 TMI -0.338 0.001 0.195 0.055
NAMI -0.349 <0.001 0.231 0.022
FI 0.185 >0.05 -0.217 0.032
表3 术后5次坐立时间和6 m行走步速的多元线性回归分析
Table 3 Multivariate linear regression analyses on time of five times sit-to-stand test and six-meter walking speed after surgery
模型
Model		 模型P值
Model P value		 R2 调整R2
Adjusted R2		 B 95% CI P值 VIF
5次坐立时间
Five times sit-to-stand test time		 常量
Constant		 <0.001 0.261 0.237 13.057 （7.661，18.451） <0.001 -
年龄
Age		 0.123 （0.053，0.193） <0.001 1.035
对侧臀大肌TMI
Contralateral gluteus maximus TMI		 -0.438 （-0.701，-0.176） 0.001 1.060
对侧臀小肌FI
Contralateral gluteus minimus FI		 5.948 （1.272，10.624） 0.013 1.056
模型
Model		 模型P值
Model P value		 R2 调整R2
Adjusted R2		 B 95% CI P值 VIF
6 m行走步速
Six-meter walking speed		 常量
Constant		 <0.001 0.230 0.205 1.156 （0.858，1.454） <0.001 -
年龄
Age		 -0.006 （-0.010，-0.003） <0.001 1.001
对侧臀小肌TMI
Contralateral gluteus minimus TMI		 0.047 （0.006，0.088） 0.025 1.001
对侧髂腰肌FI
Contralateral iliopsoas FI		 -1.178 （-1.864，-0.491） <0.001 1.001
表4 观察者内和观察者间稳定性
Table 4 Intra- and interobserver reliability
影响因素
Factors		 观察者内
Intraobserver		 观察者间
Interobserver
ICC 95%CI ICC 95%CI
下肢长度差异
Limb length discrepancy		 0.978 （0.915，0.995） 0.902 （0.770，0.960）
髋臼偏心距差异
Acetabular offset discrepancy		 0.990 （0.962，0.998） 0.930 （0.833，0.972）
股骨偏心距差异
Femoral offset discrepancy		 0.988 （0.953，0.969） 0.924 （0.818，0.969）
术侧肌肉成分
Muscle composition on the operative side
臀大肌
Gluteus maximus		 NAMA 0.987 （0.948，0.997） 0.985 （0.940，0.996）
LAMA 0.968 （0.876，0.992） 0.961 （0.851，0.990）
IMAA 0.937 （0.769，0.984） 0.904 （0.661，0.975）
臀中肌
Gluteus medius		 NAMA 0.981 （0.925，0.995） 0.979 （0.918，0.995）
LAMA 0.943 （0.790，0.986） 0.930 （0.745，0.982）
IMAA 0.930 （0.746，0.982） 0.917 （0.704，0.979）
臀小肌
Gluteus minimus		 NAMA 0.969 （0.881，0.992） 0.963 （0.859，0.991）
LAMA 0.958 （0.842，0.989） 0.953 （0.824，0.988）
IMAA 0.923 （0.721，0.980） 0.912 （0.689，0.978）
髂腰肌
Iliopsoas		 NAMA 0.947 （0.801，0.986） 0.956 （0.835，0.989）
LAMA 0.950 （0.812，0.987） 0.921 （0.715，0.980）
IMAA 0.927 （0.735，0.981） 0.926 （0.733，0.981）
梨状肌
Piriformis		 NAMA 0.994 （0.975，0.998） 0.991 （0.963，0.998）
LAMA 0.947 （0.804，0.987） 0.956 （0.836，0.989）
IMAA 0.925 （0.729，0.981） 0.906 （0.670，0.976）
股直肌
Rectus femoris		 NAMA 0.997 （0.988，0.999） 0.977 （0.910，0.994）
LAMA 0.979 （0.918，0.995） 0.966 （0.870，0.991）
IMAA 0.988 （0.951，0.997） 0.966 （0.869，0.991）
对侧肌肉成分
Muscle composition on the non-operative side
臀大肌
Gluteus maximus		 NAMA 0.991 （0.964，0.998） 0.985 （0.943，0.996）
LAMA 0.993 （0.971，0.998） 0.982 （0.928，0.995）
IMAA 0.976 （0.908，0.994） 0.959 （0.843，0.990）
臀中肌
Gluteus medius		 NAMA 0.957 （0.838，0.989） 0.944 （0.793，0.986）
LAMA 0.949 （0.809，0.987） 0.931 （0.747，0.982）
IMAA 0.939 （0.775，0.984） 0.911 （0.685，0.977）
臀小肌
Gluteus minimus		 NAMA 0.963 （0.860，0.991） 0.957 （0.837，0.989）
LAMA 0.965 （0.866，0.991） 0.935 （0.761，0.983）
IMAA 0.940 （0.777，0.985） 0.909 （0.677，0.976）
髂腰肌
Iliopsoas		 NAMA 0.974 （0.901，0.994） 0.975 （0.904，0.994）
LAMA 0.974 （0.901，0.994） 0.935 （0.762，0.983）
IMAA 0.943 （0.787，0.985） 0.936 （0.764，0.984）
梨状肌
Piriformis		 NAMA 0.981 （0.925，0.995） 0.975 （0.903，0.994）
LAMA 0.989 （0.955，0.997） 0.954 （0.825，0.988）
IMAA 0.942 （0.785，0.985） 0.910 （0.681，0.977）
股直肌
Rectus femoris		 NAMA 0.986 （0.943，0.996） 0.961 （0.852，0.990）
LAMA 0.989 （0.957，0.997） 0.952 （0.819，0.988）
IMAA 0.966 （0.870，0.991） 0.956 （0.833，0.989）
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