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( =:6<-35-/:= 2 ABBILDUNGSVERZEICHNIS... 6 TABELLENVERZEICHNIS... 7 1. Einleitung... 8 2. Forschungsstand... 10 2.1. Anatomie des Hüftgelenks... 10 2.2. Arthrose des Hüftgelenks... 11 2.2.1. Begriffsbestimmung der Arthrose... 11 2.2.2. Epidemiologie... 11 2.2.3. Klinik der Coxarthrose... 12 2.2.4. Scores und Bewertungsschemata zur Coxarthrose... 12 2.2.5. Therapie der Coxarthrose... 12 2.2.6. Symptomatik der Coxarthrose... 13 2.3. Trendelenburg-Duchenne-Hinken... 15 2.4. Ganganalyse... 16 2.4.1. Allgemeine Aspekte... 16 2.4.2. Coxarthrose... 20 2.4.3. Stellenwert von Wirbelsäulen- und Beckenbewegung... 23 2.4.4. Nicht-klassische Untersuchungsmethoden ganganalytischer Daten... 25 2.4.5. Elektromyographie... 26 2.5. Prozessorientierte Analyse... 30 2.6. Forschungsdefizite... 32 3. Problemstellung... 33 4. Methodik... 34 4.1. Personenstichprobe... 34 4.1.1. Stichprobenauswahl der Schritte... 35 4.2. Datenerhebung... 35 4.2.1. Ganganalyse... 36 4.2.1.1. Testvorbereitung... 36

( > 4.2.1.2. Testdurchführung... 38 4.2.1.3. Messfehler... 40 4.2.2. Anamnese und Fragebogenscore... 40 4.3. Datenauswertung... 41 4.3.1. Vorbereitung... 41 4.3.2. Gleichrichten und Filtern... 42 4.3.3. Normierung... 43 4.3.4. Korrelation mit orthogonalen Referenzfunktionen... 44 4.3.5. Vergleich der Korrelationsmatrizen... 46 4.3.6. Clusteranalyse... 48 4.3.7. Assessment Rate (AR)... 49 4.3.8. Zusammenfassung... 50 5. Ergebnisse... 51 5.1. Kinematische Merkmale des thorakalen Ultraschall-Triplets... 51 5.2. Kontrollgruppe... 52 5.2.1. Kinematik und EMG (alle 8 Merkmale)... 52 5.2.2. Kinematik (thorakale und sakrale Merkmale)... 53 5.2.3. Kinematik (sakrale Merkmale)... 53 5.2.4. Elektromyographische Merkmale... 54 5.2.5. Fünf Beckenmerkmale... 54 5.2.6. Zusammenfassung... 54 5.3. Versuchsgruppe... 55 5.3.1. Kinematik und EMG (8 Merkmale) Komplette Versuchsgruppe... 56 5.3.2. Kinematik (sakrale Merkmale) Komplette Versuchsgruppe... 56 5.3.3. Kinematik (sakrale Merkmale) Homogene Versuchsgruppe... 57 5.3.4. Elektromyographische Merkmale Komplette Versuchsgruppe... 57 5.3.5. Elektromyographische Merkmale Homogene Versuchsgruppe... 57 5.3.6. Fünf Beckenmerkmale Komplette Versuchsgruppe... 58 5.3.7. Fünf Beckenmerkmale Homogene Versuchsgruppe... 59 5.3.8. Zusammenfassung... 60 5.4. Gemeinsame Analyse aller Probanden... 62 5.4.1. Kinematik (sakrale Merkmale) Komplette Versuchsgruppe... 62

( 9 5.4.2. Kinematik (sakrale Merkmale) Homogene Versuchsgruppe... 63 5.4.3. Elektromyographische Merkmale Komplette Versuchsgruppe... 64 5.4.4. Elektromyographische Merkmale Homogene Versuchsgruppe... 64 5.4.5. Fünf Beckenmerkmale Komplette Versuchsgruppe... 65 5.4.6. Fünf Beckenmerkmale Homogene Versuchsgruppe... 65 5.4.7. Zusammenfassung... 66 6. Diskussion und Ausblick... 68 7. Literaturverzeichnis... 82 Anhang I - Dendrogramme der interindividuellen Analyse... 101 Kontrollgruppe... 102 Homogene Versuchsgruppe... 105 Versuchsgruppe (komplett)... 108 Kontrollgruppe und homogene Versuchsgruppe zusammen... 114 Kontrollgruppe und komplette Versuchsgruppe zusammen... 120 Anhang II Fragebögen... 128 Allgemeiner Teil... 128 Spezieller Teil... 129 WOMAC... 129 Harris-Hip-Score... 133 Anhang III Patienten-Daten... 134 Kontrollgruppe... 134 Versuchsgruppe... 135 Anhang IV Ausgewählte Schritte (Liste)... 138 Anhang V Beispiel der Auswirkung verschiedener Breiten des moving-average -Fensters auf das EMG-Profil... 139 ZUSAMMENFASSUNG... 140 ABSTRACT... 142 ERKLÄRUNG... 143 LEBENSLAUF... 144

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717 2,!/./,33!!/"!/?!!,70! Legende: Kontrollgruppe: Versuchsgruppe: AA060745 AT090229 DK040230 DM310542 IS230644 KH040344 MS291244 RA050941 RK180854 RL220147 UB160143 AF050334 AG180357 ER140935 GB300355 HH100130 HS180731 JB050243 LD280337 LW271044 PH080741 RD131246 UH130745 +AK140436 +CL010942 +IO181232 +WH030830 +EW180230 +GG060324 +HB290430 +IH280948 +SU020747 Q< - +

710."/./88! 47F,+ Rescaled Distance Cluster Combine C A S E 0 5 10 15 20 25 Label Num +---------+---------+---------+---------+---------+ DM310_17 35 DM310_29 38 DM310_42 42 DM310_31 39 DM310_38 41 DM310_45 43 DM310_26 36 DM310_49 44 KH040_02 57 DM310_04 34 DM310_33 40 DM310_28 37 AA060_40 8 KH040_01 56 KH040_05 58 RL220_33 105 RL220_39 108 RL220_04 100 RL220_44 109 RL220_17 102 RL220_21 103 RL220_31 104 RL220_34 106 RL220_36 107 RL220_53 110 RL220_09 101 KH040_15 61 KH040_23 64 KH040_21 62 KH040_26 65 KH040_06 59 MS291_25 75 MS291_29 76 MS291_22 73 MS291_09 69 MS291_14 71 KH040_22 63 MS291_16 72 MS291_23 74 RK180_22 92 RK180_39 96 RK180_45 97 RK180_46 98 RK180_31 95 RK180_49 99 MS291_13 70 MS291_36 77 MS291_06 68 IS230_06 46 IS230_41 53 IS230_07 47 IS230_37 51 IS230_43 54 IS230_39 52 IS230_29 49 IS230_30 50 IS230_02 45 IS230_21 48 IS230_46 55 MS291_04 67 AT090_15 12 AT090_18 14 AA060_47 9 AA060_54 10 AA060_32 6 AA060_59 11 AA060_06 1 AA060_07 2 AA060_39 7 UB160_25 114 UB160_26 115 AT090_61 22 RA050_27 83 UB160_32 116 UB160_01 111 UB160_46 121 UB160_10 113 UB160_36 117 UB160_45 120 UB160_08 112 UB160_41 119 AA060_09 3 AA060_21 4 AA060_27 5 RA050_33 84 RA050_50 88 RA050_14 81 RA050_48 87 RA050_05 78 RA050_10 80 RA050_17 82 RA050_39 85 RA050_46 86 RA050_07 79 DK040_25 24 UB160_37 118 AT090_50 20 DK040_31 26 AT090_58 21 DK040_14 23 DK040_37 27 DK040_49 28 DK040_51 29 DK040_61 32 DK040_29 25 DK040_78 33 DK040_57 30 DK040_59 31 AT090_20 15 AT090_26 16 AT090_40 18 AT090_44 19 AT090_28 17 AT090_16 13 KH040_35 66 RK180_12 90 RK180_15 91 RK180_04 89 KH040_08 60 RK180_29 94 RK180_27 93 40?+,+ Rescaled Distance Cluster Combine C A S E 0 5 10 15 20 25 Label Num +---------+---------+---------+---------+---------+ DM310_17 35 DM310_29 38 DM310_42 42 DM310_31 39 DM310_38 41 DM310_45 43 DM310_26 36 DM310_49 44 KH040_02 57 DM310_04 34 DM310_33 40 DM310_28 37 AA060_40 8 KH040_05 58 RL220_17 102 RL220_33 105 RL220_39 108 RL220_04 100 RL220_21 103 RL220_44 109 RL220_09 101 KH040_15 61 KH040_23 64 KH040_21 62 KH040_26 65 KH040_06 59 RK180_22 92 RK180_39 96 MS291_13 70 MS291_36 77 MS291_06 68 IS230_29 49 IS230_30 50 IS230_37 51 IS230_43 54 IS230_39 52 IS230_02 45 RK180_31 95 RK180_49 99 KH040_01 56 RK180_45 97 RK180_46 98 RL220_31 104 RL220_34 106 RL220_36 107 RL220_53 110 IS230_21 48 IS230_46 55 IS230_07 47 IS230_41 53 IS230_06 46 MS291_22 73 MS291_25 75 MS291_29 76 KH040_22 63 MS291_14 71 MS291_09 69 MS291_16 72 MS291_23 74 DK040_14 23 DK040_37 27 DK040_61 32 DK040_49 28 DK040_51 29 DK040_57 30 MS291_04 67 DK040_31 26 DK040_59 31 DK040_29 25 DK040_78 33 DK040_25 24 UB160_37 118 AT090_15 12 AT090_18 14 AT090_20 15 AT090_26 16 AT090_50 20 AT090_40 18 AT090_44 19 AT090_16 13 KH040_35 66 AT090_28 17 RK180_12 90 RK180_15 91 RK180_04 89 KH040_08 60 RK180_29 94 AT090_58 21 RK180_27 93 AT090_61 22 UB160_26 115 AA060_47 9 AA060_54 10 AA060_32 6 AA060_59 11 AA060_06 1 AA060_07 2 AA060_39 7 RA050_27 83 UB160_32 116 RA050_07 79 UB160_08 112 UB160_25 114 UB160_10 113 UB160_45 120 UB160_36 117 UB160_46 121 UB160_41 119 UB160_01 111 AA060_09 3 AA060_27 5 AA060_21 4 RA050_33 84 RA050_50 88 RA050_14 81 RA050_05 78 RA050_39 85 RA050_46 86 RA050_10 80 RA050_17 82 RA050_48 87

712 422+ +,+ Rescaled Distance Cluster Combine C A S E 0 5 10 15 20 25 Label Num +---------+---------+---------+---------+---------+ DM310_45 43 DM310_17 35 DM310_29 38 DM310_31 39 DM310_38 41 DM310_26 36 KH040_15 61 KH040_26 65 RA050_07 79 4>2+ +,+ Rescaled Distance Cluster Combine C A S E 0 5 10 15 20 25 Label Num +---------+---------+---------+---------+---------+ AT090_20 15 DK040_57 30 AT090_26 16 DM310_04 34 DM310_28 37 KH040_22 63 RL220_34 106 MS291_09 69 RK180_46 98 IS230_37 51 IS230_43 54 IS230_07 47 IS230_21 48 IS230_46 55 IS230_41 53 RL220_21 103 IS230_02 45 IS230_39 52 IS230_29 49 IS230_30 50 MS291_13 70 MS291_36 77 MS291_06 68 RL220_17 102 RL220_44 109 RL220_04 100 RL220_33 105 IS230_06 46 RL220_53 110 RL220_34 106 RL220_36 107 RL220_31 104 RL220_39 108 RK180_46 98 RL220_09 101 RK180_22 92 RK180_39 96 RK180_31 95 RK180_45 97 KH040_01 56 KH040_05 58 RK180_49 99 MS291_16 72 MS291_23 74 MS291_14 71 MS291_22 73 MS291_25 75 MS291_29 76 KH040_22 63 UB160_25 114 UB160_26 115 RK180_27 93 RA050_17 82 UB160_41 119 UB160_08 112 UB160_36 117 UB160_45 120 AT090_15 12 AT090_18 14 DK040_49 28 DK040_51 29 DK040_37 27 DK040_14 23 DK040_59 31 DK040_78 33 DK040_29 25 DK040_57 30 DK040_25 24 AT090_40 18 AT090_44 19 DK040_31 26 DK040_61 32 MS291_04 67 AT090_58 21 AT090_61 22 MS291_09 69 RA050_05 78 RA050_50 88 AA060_27 5 RA050_14 81 RA050_27 83 AA060_06 1 AA060_59 11 AA060_07 2 AA060_32 6 AA060_47 9 AA060_54 10 KH040_06 59 KH040_23 64 KH040_21 62 UB160_32 116 AA060_39 7 KH040_08 60 KH040_35 66 AT090_20 15 AT090_26 16 AT090_16 13 AT090_50 20 RK180_12 90 RK180_15 91 RK180_04 89 RK180_29 94 AT090_28 17 DM310_17 35 DM310_29 38 DM310_31 39 DM310_38 41 DM310_42 42 KH040_15 61 RL220_44 109 DM310_26 36 DM310_49 44 AT090_18 14 RL220_04 100 DM310_33 40 RL220_21 103 DM310_45 43 MS291_29 76 KH040_23 64 MS291_22 73 MS291_25 75 KH040_05 58 KH040_21 62 KH040_26 65 RL220_33 105 RL220_39 108 KH040_02 57 KH040_01 56 RK180_45 97 MS291_13 70 MS291_36 77 MS291_06 68 MS291_04 67 MS291_16 72 RK180_22 92 RK180_39 96 AT090_15 12 AA060_40 8 RL220_17 102 KH040_06 59 AT090_16 13 AT090_28 17 KH040_35 66 RK180_04 89 RK180_15 91 RK180_29 94 RK180_12 90 RK180_27 93 KH040_08 60 RA050_07 79 RA050_27 83 RL220_53 110 RL220_31 104 RL220_36 107 MS291_23 74 RK180_31 95 RA050_14 81 RK180_49 99 AA060_27 5 RA050_48 87 UB160_37 118 IS230_46 55 RA050_17 82 MS291_14 71 RA050_10 80 IS230_41 53 IS230_37 51 IS230_39 52 IS230_43 54 IS230_29 49 IS230_30 50 IS230_02 45 IS230_21 48 IS230_06 46 RA050_05 78 RA050_46 86 RA050_39 85 IS230_07 47 AT090_44 19 UB160_26 115 AT090_40 18 AA060_09 3 AA060_21 4 AA060_47 9 AA060_54 10 RL220_09 101 AA060_32 6 AA060_59 11 UB160_25 114 UB160_36 117 UB160_01 111 UB160_46 121 UB160_08 112 AA060_06 1 AA060_07 2 AA060_39 7 AT090_61 22 UB160_46 121 UB160_32 116 UB160_10 113 AT090_50 20 UB160_37 118 DK040_31 26 AA060_09 3 DK040_59 31 AA060_21 4 UB160_10 113 AA060_40 8 UB160_45 120 RA050_39 85 RA050_46 86 RA050_33 84 UB160_01 111 RA050_48 87 RA050_10 80 DM310_28 37 DM310_49 44 DM310_42 42 KH040_02 57 DM310_04 34 RA050_33 84 RA050_50 88 AT090_58 21 UB160_41 119 DK040_49 28 DK040_51 29 DK040_14 23 DK040_37 27 DK040_61 32 DK040_29 25 DK040_78 33 DM310_33 40 DK040_25 24

71> 490 +E,+ Rescaled Distance Cluster Combine C A S E 0 5 10 15 20 25 Label Num +---------+---------+---------+---------+---------+ MS291_06 68 MS291_09 69 MS291_25 75 MS291_16 72 MS291_36 77 MS291_13 70 DM310_28 37 RA050_27 83 MS291_23 74 MS291_14 71 MS291_29 76 UB160_36 117 UB160_41 119 AA060_06 1 AA060_32 6 AA060_21 4 UB160_10 113 RL220_31 104 RL220_36 107 RL220_04 100 RL220_17 102 RL220_33 105 RL220_39 108 AA060_47 9 AA060_54 10 AA060_27 5 AA060_59 11 AA060_07 2 KH040_26 65 DM310_31 39 UB160_08 112 DM310_26 36 DM310_49 44 RA050_17 82 DM310_29 38 DM310_38 41 DM310_04 34 DM310_45 43 DM310_17 35 DM310_42 42 AA060_09 3 AA060_39 7 IS230_07 47 DM310_33 40 AA060_40 8 IS230_02 45 AT090_15 12 AT090_61 22 RA050_10 80 RA050_14 81 RA050_48 87 RA050_50 88 RA050_07 79 RA050_39 85 UB160_37 118 RA050_33 84 RL220_09 101 RL220_21 103 IS230_39 52 MS291_04 67 MS291_22 73 KH040_05 58 KH040_06 59 RK180_49 99 RL220_34 106 RL220_44 109 RL220_53 110 UB160_45 120 UB160_46 121 UB160_32 116 UB160_01 111 KH040_01 56 KH040_15 61 AT090_18 14 KH040_21 62 KH040_02 57 KH040_22 63 KH040_23 64 IS230_21 48 IS230_43 54 IS230_41 53 IS230_29 49 RA050_46 86 IS230_46 55 IS230_06 46 IS230_30 50 IS230_37 51 RA050_05 78 UB160_26 115 DK040_25 24 RK180_12 90 AT090_58 21 KH040_35 66 KH040_08 60 AT090_16 13 AT090_50 20 DK040_29 25 DK040_37 27 DK040_14 23 RK180_15 91 DK040_31 26 DK040_57 30 DK040_51 29 RK180_04 89 UB160_25 114 RK180_45 97 RK180_46 98 RK180_31 95 RK180_22 92 RK180_39 96 RK180_27 93 RK180_29 94 DK040_59 31 DK040_78 33 DK040_49 28 DK040_61 32 AT090_26 16 AT090_28 17 AT090_20 15 AT090_44 19 AT090_40 18 4?9"+ + Rescaled Distance Cluster Combine C A S E 0 5 10 15 20 25 Label Num +---------+---------+---------+---------+---------+ DM310_17 17 DM310_29 80 DM310_31 19 DM310_38 20 DM310_04 78 DM310_33 81 DM310_45 21 DM310_42 82 DM310_28 18 DM310_49 83 KH040_02 28 DM310_26 79 RL220_44 54 RL220_17 112 RL220_04 111 RL220_39 115 RL220_33 52 RL220_36 53 RL220_34 114 RL220_31 113 RL220_53 116 RL220_09 50 MS291_36 38 MS291_13 96 MS291_06 95 IS230_29 24 IS230_30 86 IS230_37 25 IS230_43 88 IS230_02 22 IS230_39 87 IS230_46 27 IS230_21 85 IS230_41 26 IS230_07 23 RL220_21 51 IS230_06 84 RK180_22 107 RK180_39 109 RK180_31 47 RK180_45 48 KH040_01 89 KH040_05 90 RK180_49 49 RK180_46 110 UB160_26 57 UB160_25 118 RK180_27 46 AA060_47 4 AA060_54 66 AA060_59 5 AA060_06 61 AA060_07 62 AA060_32 64 RA050_14 40 RA050_27 41 RA050_05 100 UB160_32 119 AA060_39 3 KH040_06 29 KH040_23 93 KH040_15 30 KH040_21 92 KH040_26 32 MS291_25 37 MS291_29 99 MS291_14 35 MS291_22 36 MS291_23 98 MS291_16 97 AA060_09 1 AA060_21 63 AA060_40 65 UB160_01 55 RA050_33 103 RA050_48 43 RA050_46 104 RA050_50 105 RA050_10 101 RA050_39 42 AA060_27 2 UB160_46 60 UB160_45 121 UB160_36 58 UB160_08 117 UB160_41 59 UB160_10 56 RA050_17 102 UB160_37 120 KH040_22 31 RA050_07 39 AT090_44 9 DK040_31 74 DK040_61 77 DK040_14 11 DK040_37 13 DK040_49 75 DK040_59 15 DK040_78 16 DK040_51 14 DK040_57 76 DK040_29 12 DK040_25 73 AT090_15 67 AT090_18 68 AT090_58 10 AT090_61 72 MS291_04 33 MS291_09 34 AT090_20 7 AT090_26 69 AT090_40 70 AT090_28 8 RK180_15 45 RK180_12 106 RK180_04 44 KH040_08 91 AT090_16 6 AT090_50 71 KH040_35 94 RK180_29 108