Allison Kim, Hall Michelle, Wrigley Tim V, Pua Yong-Hao, Metcalf Ben, Bennell Kim L
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, Australia.
Department of Physiotherapy, Singapore General Hospital, Singapore.
Gait Posture. 2018 Sep;65:234-239. doi: 10.1016/j.gaitpost.2018.07.179. Epub 2018 Jul 31.
Hip osteoarthritis (OA) is a significant cause of disability, with hip pain and reduced external hip moments during walking being key features of the condition. The external hip adduction moment is greater in healthy women than men, however these between-sex differences are not evident in those with end-stage hip OA. Whether sex-specific hip kinetics are associated with early-midstage hip OA has not been investigated and may be a potential target for directed treatment.
Thirty-eight women and twenty-eight men with a diagnosis of symptomatic, unilateral, mild-to-moderate hip OA (Kellegren-Lawrence Grade 2 or 3) underwent three-dimensional gait analysis of normal walking gait using Vicon motion capture. Hip joint, trunk and pelvic angles and hip moments were calculated using the Plug-in-Gait model. The external peak flexion moment, and the first peak, second peak and mid-stance minimum of the hip adduction moment during the stance phase of walking as well as hip, trunk and pelvic kinematics occurring at the three moment time points were compared between groups using an analysis of covariance.
Women with hip OA exhibited a greater external hip adduction moment (mean difference 0.8-1.3 N m/BW.Ht(%), P < 0.05) and greater hip adduction angles (mean difference 2.8-4.9 degrees, P < 0.05) throughout stance than men. Men walked with a greater forward trunk lean than women during early to midstance (mean difference 2.9-3.5 degrees, P < 0.05) than women.
In contrastto late stage hip OA, between-sex difference in hip joint kinematics and kinetics are preserved in early-midstage hip OA.
髋关节骨关节炎（OA）是导致残疾的重要原因，髋关节疼痛和行走时髋关节外展力矩降低是该疾病的关键特征。健康女性的髋关节内收力矩大于男性，然而在终末期髋关节OA患者中，这种性别差异并不明显。性别特异性的髋关节动力学是否与早中期髋关节OA相关尚未得到研究，可能是定向治疗的潜在靶点。
38名诊断为有症状的单侧轻度至中度髋关节OA（Kellegren-Lawrence分级2级或3级）的女性和28名男性，使用Vicon动作捕捉系统对正常行走步态进行三维步态分析。使用插入式步态模型计算髋关节、躯干和骨盆角度以及髋关节力矩。使用协方差分析比较两组之间行走支撑相期间的髋关节外展峰值力矩、髋关节内收力矩的第一峰值、第二峰值和支撑中期最小值，以及在这三个力矩时间点出现的髋关节、躯干和骨盆运动学指标。
与男性相比，髋关节OA女性在整个支撑期表现出更大的髋关节外展力矩（平均差异0.8 - 1.3 N·m/BW·Ht(%)，P < 0.05）和更大的髋关节内收角度（平均差异2.8 - 4.9度，P < 0.05）。在支撑早期至中期，男性比女性有更大的躯干前倾（平均差异2.9 - 3.5度，P < 0.05）。
与晚期髋关节OA不同，早中期髋关节OA中髋关节运动学和动力学的性别差异仍然存在。
