Nepple Jeffrey J, Riggs Cassandra N, Ross James R, Clohisy John C
Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Campus Box 8233, St. Louis, MO 63110. E-mail address for J.J. Nepple:
J Bone Joint Surg Am. 2014 Oct 15;96(20):1683-9. doi: 10.2106/JBJS.M.01320.
BACKGROUND: Cam-type femoroacetabular impingement (FAI) is generally described as being more common in males, with pincer-type FAI being more common in females. The purpose of this study was to determine the effect of sex on FAI subtype, clinical presentation, radiographic findings, and intraoperative findings in patients with symptomatic FAI. METHODS: We compared cohorts of fifty consecutive male and fifty consecutive female patients who were undergoing surgery for symptomatic FAI. Detailed information regarding clinical presentation, radiographic findings, and intraoperative pathology was recorded prospectively and analyzed. FAI subtype was classified on the basis of clinical diagnosis and radiographic evaluation. RESULTS: Female patients had significantly greater disability at presentation, as measured with use of the modified Harris hip score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Hip Disability and Osteoarthritis Outcome Score (HOOS), and the SF-12 (12-Item Short Form Health Survey) physical function subscore (all p ≤ 0.02), despite a significantly lower UCLA (University of California at Los Angeles) activity score (p = 0.03). Female patients had greater hip motion (flexion and internal rotation and external rotation in 90° of flexion; all p ≤ 0.003) and less severe cam-type morphologies (a mean maximum alpha angle of 57.6° compared with 70.8° for males; p < 0.001). Males were significantly more likely to have advanced acetabular cartilage lesions (56% of males compared with 24% of females; p = 0.001) and larger labral tears with more posterior extension of these abnormalities (p < 0.02). Males were more likely than females to have mixed-type FAI and thus a component of pincer-type FAI (combined-type FAI) (62% of males compared with 32% of females; p = 0.003). CONCLUSIONS: We found distinct, sex-dependent disease patterns in patients with symptomatic FAI. Females had more profound symptomatology and milder morphologic abnormalities, while males had a higher activity level, larger morphologic abnormalities, more common combined-type FAI morphologies, and more extensive intra-articular disease. LEVEL OF EVIDENCE: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
背景：凸轮型股骨髋臼撞击症（FAI）通常被认为在男性中更为常见，而钳夹型FAI在女性中更为常见。本研究的目的是确定性别对有症状FAI患者的FAI亚型、临床表现、影像学表现和术中表现的影响。 方法：我们比较了连续50例接受有症状FAI手术的男性患者和连续50例接受有症状FAI手术的女性患者队列。前瞻性记录并分析了有关临床表现、影像学表现和术中病理的详细信息。FAI亚型根据临床诊断和影像学评估进行分类。 结果：使用改良Harris髋关节评分（mHHS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、髋关节功能障碍和骨关节炎结果评分（HOOS）以及SF-12（12项简短健康调查）身体功能子评分进行测量时，女性患者在就诊时的残疾程度明显更高（所有p≤0.02），尽管加利福尼亚大学洛杉矶分校（UCLA）活动评分明显更低（p = 0.03）。女性患者的髋关节活动度更大（屈曲、90°屈曲时的内旋和外旋；所有p≤0.003），凸轮型形态异常程度较轻（平均最大α角为57.6°，男性为70.8°；p < 0.001）。男性发生晚期髋臼软骨损伤的可能性明显更高（男性为56%，女性为24%；p = 0.001），髋臼盂唇撕裂更大，且这些异常向后延伸更明显（p < 0.02）。男性比女性更有可能患有混合型FAI，因此存在钳夹型FAI成分（复合型FAI）（男性为62%，女性为32%；p = 0.003）。 结论：我们在有症状FAI患者中发现了明显的、性别依赖性的疾病模式。女性症状更严重，形态学异常更轻，而男性活动水平更高，形态学异常更大，复合型FAI形态更常见，关节内疾病更广泛。 证据水平：预后I级。有关证据水平的完整描述，请参阅作者须知。
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