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Universidad De Murcia Facultad De Biología UNIVERSIDAD DE MURCIA FACULTAD DE BIOLOGÍA The role of iliopsoas muscle in the development of degenerative disease of the hip (Arthrosis) El papel del músculo psoas-ilíaco en el desarrollo de la coxartrosis Dª. Yulia Suvorova Suvorova 2015 THESIS The role of iliopsoas muscle in the development of degenerative disease of the hip (Arthrosis) El papel del músculo psoas-ilíaco en el desarrollo de la coxartrosis Realizada por Doña Yulia Suvorova Suvorova Dirigida por Don Aurelio Luna Maldonado Don José Emilio Muñoz Barrio 1 Acknowledgments: To my husband, Dr. R.E. Conger for all the support and love. To Dr. Aurelio Luna Maldonado, Dr. José Emilio Muñoz Barrio and Dra. María Dolores García García for all the professional advice and input. To the team of Faculty of Biology and Medicine and Department of Forensic Science University of Murcia. To my parents and my lovely doggies Lola, Teddy, Buffy and Linda. 2 “and the knowledge of the iliopsoas muscle” --- Dr. R.E. Conger 3 INDEX 1 Resumen………………………………………………………………………7 2 Introduction……………………………………………………………….24 3 CHAPTER I ........................................................................................... 27 3.1 BACKGROUND: ........................................................................ 27 3.2 PURPOSE OF WORK: ................................................................. 29 3.3 GLOBAL OVERVIEW : ................................................................ 29 3.3.1 The Most Important Muscle Syndrome ..................................... 29 3.3.1.1 Iliopsoas ...................................................................................... 31 3.3.1.2 Origin..................................................................................... 33 3.3.1.3 Insertion ................................................................................ 33 3.3.1.4 Innervation ............................................................................ 33 3.3.1.5 Properties ............................................................................. 34 3.3.2 Anthropology .............................................................................. 35 3.3.2.1 Prehuman Ancestors .................................................................. 35 3.3.2.2 Anthropoidea .............................................................................. 36 3.3.2.3 The Erect Posture as a Factor in Production of Anomalies in Man specifically in the hip joints ............................................................... 37 3.3.3 The Iliopsoas Imbalance ............................................................ 38 3.3.3.1 In the beginning: causes of muscles imbalance ...................... 38 3.3.3.2 The Crucial Years ....................................................................... 38 3.3.3.3 From Ape to Modern Man-The Key ........................................... 40 3.3.4 How the Bones and Muscles work ............................................ 44 3.3.4.1 The Body’s Engineering System ............................................... 44 3.3.4.2 Kind of Joints .............................................................................. 47 3.3.4.3 What is a Muscle? What Does It Do? ........................................ 48 3.3.4.4 Muscle Attachments ................................................................... 50 3.3.4.5 One Muscle Can Affect Your Entire Body ................................ 52 3.3.5 Physical Properties of the Pelvis, Sacro-iliac and Hip Joint the bridge between the upper and lower body ......................................... 55 3.3.5.1 Orientation of the pelvis ............................................................. 55 3.3.5.2 Movement of the Pelvis .............................................................. 56 4 3.3.5.3 The Sacroiliac Articulation ........................................................ 56 3.3.5.4 Physical Properties of the Hip joint .......................................... 56 3.3.5.5 Position of the Acetabulum and Femoral Head ....................... 57 3.3.5.6 Position of the Femoral Neck .................................................... 57 3.3.5.7 Functional Mobility of the Hip Joint .......................................... 59 3.3.5.8 Ligamentous Reinforcement of the Hip Joint .......................... 59 3.3.6 The Hip Arthrosis (Coxarthrosis) .............................................. 60 3.3.6.1 Anatomy of the hip and Coxarthrosis (Arthrosis of the hip) ... 60 3.3.6.2 Etiology and risk factors: ........................................................... 62 3.3.6.3 Pathomechanics of the Hip Arthrosis: ...................................... 64 3.3.6.4 Evaluation: .................................................................................. 67 3.3.7 Final Remarks: ............................................................................ 69 3.4 MAIN AIM: .................................................................................... 70 3.5 SECONDARY AIMS: .................................................................... 70 3.5.1 To find out the factors that determine hip arthrosis ................ 70 3.5.2 To make profiles of individuals who are likely to develop hip arthrosis in the future due to their current features of today ........... 70 3.6 HYPOTHESIS: ............................................................................. 70 4 CHAPTER II. METHODOLOGY ................................................... 71 4.1 METHODS AND TOOLS .............................................................. 71 4.1.1 DATA: .......................................................................................... 71 4.1.2 METHODS:................................................................................... 74 4.1.2.1 Discriminant Factorial Analysis: ......................................... 74 4.1.2.2 Regression Models: ............................................................. 77 A. Multivariate Linear Regression: ................................................ 77 B. Logistic Regression: .................................................................. 83 4.1.2.3 Clusters Analysis: ................................................................ 87 4.1.2.4 Analysis of Variance (ANOVA): ........................................... 88 4.1.3 DATA REVIEW: ........................................................................... 91 4.1.4 FINAL DATA: ............................................................................... 92 4.2 ANALYSIS AND RESULTS: ........................................................ 93 4.2.1 Sample Descriptive Statistics Analysis: ................................... 95 5 4.2.2 Clusters Analysis:………………………………………………….102 4.2.2.1 Results: ............................................................................... 103 4.2.3 Analysis of Variance (ANOVA): ............................................... 106 4.2.3.1 Model Specification: .......................................................... 106 4.2.3.2 Results: ............................................................................... 107 4.2.3.3 Assumptions Validation: ................................................... 110 4.2.3.4 One Way Analysis: ............................................................. 114 4.2.3.5 Kruskal-Wallis Test ............................................................ 123 4.2.4 Multivariate Logistic Regression: ........................................... 131 4.2.4.1 Model Specification: .......................................................... 131 4.2.4.2 Regression Models: ........................................................... 132 4.2.5 Multivariate General Regression: ............................................ 140 4.2.5.1 Model Specification: .......................................................... 140 4.2.6 Discriminant Factorial Analysis: ............................................. 141 4.2.6.1 Literature Review: .............................................................. 146 4.3 DISCUSSION: ............................................................................ 156 5 CHAPTER III ........................................................................................ 160 5.1 RESEARCH QUESTIONS ......................................................... 160 5.2 CONCLUSSIONS ....................................................................... 160 5.3 BIBLIOGRAPHY ........................................................................ 163 5.4 ANNEXES .................................................................................. 165 5.4.1 NEWTON-RAPHSON ALGORITHM: ......................................... 165 Algorithm ...................................................................................................... 166 5.4.2 EVOLUTION OF ARTHROSIS: .................................................. 167 6 1 RESUMEN IDEA GENERAL: El músculo psoas-ilíaco (Iliopsoas) ha sido propuesto en los últimos tiempos por algunos autores como un factor de influencia en el desarrollo de Artrosis de cadera. Este proceso es lento y complejo, haciendo difícil su detección en el análisis estadístico. ANTECEDENTES: Un estudio anatómico publicado recientemente en la revista “American Journal of Sports Medicine” por Alpert, J.M., et al., (2010), identificaba por primera vez en la historia la anatomía de sección cruzada del conjunto de músculos conocido como psoas-ilíaco al nivel del labrum acetabular. Un músculo psoas-ilíaco tirante o acortado puede ser causa de un aumento en la presión intra-articular así como de un síndrome de degeneración de la cadera,
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