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BACKGROUND: The gluteus medius not only abducts the hip joint, but also plays an important role in limiting the external movement of the femoral head. At present, there is a lack of research on the correlation between gluteus medius status and non-traumatic femoral head necrosis. OBJECTIVE: To investigate the relationship between the gluteus medius width ratio and the medial space ratio of the hip joint and the progression of nontraumatic femoral head necrosis, and to explore the effect of gluteus medius atrophy on the surface and necrotic zone stress of the femoral head necrosis through finite element analysis. METHODS: Retrospective analysis of unilateral non-traumatic femoral head necrosis patients admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine was performed. All patients were followed up for an average of more than 2 years. They were divided into a collapsed group and a noncollapsed group based on whether there was collapse of the femoral head during the follow-up. Medial space ratio, gluteus medius width ratio, Sharp angle, gluteus medius length ratio, and gluteus medius activation angle were measured and calculated. The differences in these indicators were compared between the two groups. At the first visit and follow-up at 3, 6, 12, and 24 months, the medial space ratio and gluteus medius width ratio were measured and calculated to explore the changes of these two indicators in the course of non-traumatic femoral head necrosis. In addition, using three-dimensional finite element analysis, a Japanese Investigation Committee classification C1 type femoral head necrosis model was constructed based on CT data. At the same time, based on MRI data, a model of the gluteus medius muscle was constructed and divided into a gluteus medius muscle atrophy group (gluteus medius width ratio: 74%- 76%) and a gluteus medius muscle normal group (gluteus medius width ratio: 94%-96%). Each group constructed 10 models, with 6 degrees of freedom of the distal femur constrained to zero. 600 N pressures were applied along the Z-axis to the upper surface of the sacrum. The stress distribution, maximum stress values on the surface and necrotic area of the femoral head, and the maximum displacement of the necrotic area were compared between two groups of models. RESULTS AND CONCLUSION: (1) A total of 153 patients (67 males and 86 females) with 153 hips were included in this study. (2) At the 24-hour follow-up, the medial space ratio of the collapsed group was significantly higher than that of the non-collapsed group (P < 0.05). The gluteus medius width ratio of the collapsed group was significantly lower than that of the non-collapsed group (P < 0.05). There was no statistically significant difference in Sharp angle, gluteus medius activation angle, and gluteus medius length ratio between the two groups (P > 0.05). (3) Since the follow-up time exceeded 3 months, the gluteus medius width ratio of the collapsed group was lower than that of the non-collapsed group (P < 0.05). Since the follow-up time exceeded 12 months, the medial space ratio of the collapsed group was higher than that of the non-collapsed group (P < 0.05). (4) Pearson correlation analysis showed a significant positive correlation between follow-up time and medial space ratio in the collapsed group (P < 0.05), and a significant negative correlation between follow-up time and gluteus medius width ratio (P < 0.05). The regression coefficient of gluteus medius width ratio was larger than that of medial space ratio. (5) The group with middle gluteal muscle atrophy showed significant stress concentration on the surface of the femoral head, and the stress zone was significantly located on the outside. The maximum stress on the surface of the femoral head in the group with middle gluteal muscle atrophy was significantly greater than that in the group with normal middle gluteal muscle (P < 0.05). There was significant stress concentration in the necrotic area of the middle gluteal muscle atrophy group, and the maximum stress was located at the edge of the necrotic area. The maximum stress and maximum displacement in the necrotic area of the middle gluteal muscle atrophy group were significantly greater than those of the normal group (P < 0.05). (6) It is indicated that gluteus medius width ratio is an effective indicator for evaluating changes in gluteal muscle atrophy. In the progression of non-traumatic femoral head necrosis, atrophy of the gluteus medius muscle first occurs, followed by widening of the medial hip joint space. The mechanical mechanism may be that the atrophy of the gluteus medius muscle affects the stability of the hip joint, leading to external displacement of the femoral head, and increasing stress and displacement on the surface and necrotic area of the femoral head. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the predictive value of joint use of fetal head circumference, fetal abdominal circumference and angle of progression (AOP) for the difficulty of operative vaginal delivery (forceps and vaccum). Methods: This prospective observational study was carried out in Department of Obstetrics of the People′s Hospital of Guangxi Zhuang Autonomous Region from May 2017 to July 2022. A total of 64 nulliparous women with singleton term pregnancies who required instrumentation to expedite vaginal delivery during the second stage of labor were included. Clinical data of pregnant women were collected after admission to the hospital. Fetal head circumference and fetal abdominal circumference were measured. Before performing operative vaginal delivery, AOP at rest and that during uterine contraction were measured by transperineal ultrasound (AOP1: mean of AOPs at rest, AOP2: mean of AOPs during uterine contraction). According to the outcomes of operative vaginal delivery, a case was included into "difficult or failed group" (Group A) when one or more of the following situations occurred: three or more tractions needed; successful operative vaginal delivery requiring sequential instruments (change vacuum to forceps); failed operative vaginal delivery; cesarean delivery due to a subjective impression of a difficult or failed traction; birth injury and the third- or the fourth-degree perineal tear. The rest cases were included into "successful and easy group" (Group B). Fetal head circumference, fetal abdominal circumference, AOP1 and AOP2 were used to establish four different predictive models by employing multivariable logistic regression. Receiver operator characteristic (ROC) curve was used to evaluate the discrimination of four models and the model with the largest area under ROC curve (AUC) was considered as the best one. Hosmer-Lemeshow test assessed the calibration of the optimal model. The optimal one was internally validated by using Bootstrap replicated sampling (1 000 times) method. Results: Statistically significant differences were revealed with regard to fetal head station by vaginal digital examination, duration of the last traction, initial direction of pulling in the last traction, fetal abdominal circumference, AOP1, AOP2, umbilical cord artery pH and rate of neonatal asphyxia (all P＜0.05). A predictive model basing on the combination of fetal head circumference, fetal abdominal circumference, AOP1 and AOP2 showed the largest AUC (AUC=0.917, 95%CI: 0.821-0.972, Z=11.676, P＜0.001). The Hosmer-Lemeshow test showed that χ² =5.873, P= 0.661. Both of discrimination and calibration were good. The model showed good consistency in the internal validation. Conclusions: The simple model based on the combination of fetal head circumference, fetal abdominal circumference, AOP1 and AOP2 showed a predictive value for the difficulty of operative vaginal delivery and provided some basis for clinical decision-making. [ABSTRACT FROM AUTHOR]

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