Diamond Laura E, Bennell Kim L, Wrigley Tim V, Hinman Rana S, Oʼdonnell John, Hodges Paul W
1School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, AUSTRALIA; 2Department of Physiotherapy, School of Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Parkville, AUSTRALIA; 3St Vincent's Hospital, East Melbourne, AUSTRALIA; and 4School of Health and Rehabilitation Sciences, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, QLD, AUSTRALIA.
Med Sci Sports Exerc. 2017 Aug;49(8):1520-1529. doi: 10.1249/MSS.0000000000001282.
Identification of the biomechanical alterations in individuals with symptomatic femoroacetabular impingement (FAI) is critical to understand the pathology and inform treatments. Yet hip function in this condition is poorly defined. Squatting requires large hip flexion range and involves motion toward the position of hip impingement; thus, it is likely to expose modified biomechanics in these individuals. This study aimed to determine whether hip and pelvis biomechanics differ between individuals with and without symptomatic FAI during an unconstrained deep squat and a constrained squat designed to limit compensation by the pelvis and trunk.
Fifteen participants with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery and 14 age- and sex-matched controls without FAI underwent three-dimensional motion analysis during the two squatting tasks. Trunk, pelvis, and hip kinematics and hip kinetics were compared between groups.
There were no between-group differences in normalized squat depth for either task. Descent speed was slower for the FAI group during the unconstrained squat (P < 0.05). During the constrained squat, individuals with FAI demonstrated greater pelvic rise (P = 0.01) and hip adduction (P = 0.04) on the symptomatic side than controls. The hip external rotation moment was less in FAI patients during descent (P = 0.04), as was transverse plane hip angle variability (P = 0.04).
Individuals with symptomatic FAI can squat to a depth comparable with controls, regardless of task design. When the task is constrained, FAI patients demonstrate greater ipsilateral pelvic rise and maintain a more adducted hip position, which may coincide with a compensatory strategy to avoid end range flexion as the hip approaches impingement. These biomechanical alterations may put additional stress on adjacent regions and have relevance for rehabilitation.
识别有症状的股骨髋臼撞击症（FAI）患者的生物力学改变对于理解其病理及指导治疗至关重要。然而，这种情况下的髋关节功能界定尚不明确。深蹲需要较大的髋关节屈曲范围，且涉及向髋关节撞击位置的移动；因此，这可能会暴露这些个体改变的生物力学。本研究旨在确定在无约束深蹲和旨在限制骨盆及躯干代偿的约束深蹲过程中，有症状和无症状的FAI患者之间髋关节和骨盆的生物力学是否存在差异。
15名计划接受关节镜手术的有症状凸轮型或复合型（凸轮加钳夹型）FAI患者以及14名年龄和性别匹配的无FAI对照者在两项深蹲任务中接受了三维运动分析。比较了两组之间的躯干、骨盆和髋关节运动学以及髋关节动力学。
两项任务中，两组之间的标准化深蹲深度均无差异。在无约束深蹲过程中，FAI组的下降速度较慢（P < 0.05）。在约束深蹲过程中，有FAI的个体在患侧表现出比对照组更大的骨盆抬高（P = 0.01）和髋关节内收（P = 0.04）。FAI患者在下降过程中的髋关节外旋力矩较小（P = 0.04），髋关节在横平面的角度变异性也较小（P = 0.04）。
有症状的FAI患者无论任务设计如何，都能蹲到与对照组相当的深度。当任务受到约束时，FAI患者表现出更大的同侧骨盆抬高，并保持更内收的髋关节位置，这可能与一种代偿策略相符，以避免在髋关节接近撞击时出现终末范围的屈曲。这些生物力学改变可能会给相邻区域带来额外压力，与康复相关。
