Institute of Orthopedic Research and Education, Houston, Texas.
McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
J Orthop Res. 2020 Aug;38(8):1779-1786. doi: 10.1002/jor.24594. Epub 2020 Jan 27.
Traditional studies of hip kinematics have not identified which anatomic structures limit the range of motion (ROM) when the hip is placed in different maneuvers. In this study, we attempted to answer two questions: (a) During which maneuvers is the motion of the hip limited by bony impingement between the femur and pelvis? (b) When is hip ROM determined by the constraint of soft tissues and to what extent? ROM of eight cadaveric hips was measured in 17 maneuvers using a motion capture system. The maneuvers were recreated in silico using 3D CT models of each specimen to detect the occurrence of bony impingement. If bony impingement was not detected, the variable component of 3D hip motion was increased until a collision was detected. The difference between the virtual ROM at the point of bony impingement and the initial ROM measured experimentally was termed as the soft-tissue restriction. The results showed that bony impingement was present in normal hips during maneuvers consisting of high abduction with flexion, and high flexion combined with adduction and internal rotation. At impingement-free maneuvers, the degree of soft tissue restriction varies remarkably, ranging from 4.9° ± 3.8° (internal rotation) at 90° of flexion to 80.0° ± 12.5° (internal rotation) at maximum extension. The findings shed light on the relative contributions of osseous and soft tissues to the motion of the hip in different maneuvers and allow for a better understanding of physical exams of different purposes in diagnosing bone- or soft tissue-related diseases.
传统的髋关节运动学研究尚未确定在髋关节处于不同运动状态时，哪些解剖结构限制了运动范围（ROM）。在这项研究中，我们试图回答两个问题：（a）在哪些运动中，股骨和骨盆之间的骨性撞击限制了髋关节的运动？（b）髋关节 ROM 何时受到软组织的限制，限制程度如何？使用运动捕捉系统测量了 8 个尸体髋关节在 17 种运动中的 ROM。通过对每个标本的 3D CT 模型进行计算机模拟，重现了这些运动，以检测骨性撞击的发生。如果没有检测到骨性撞击，则增加 3D 髋关节运动的变量成分，直到检测到碰撞。骨性撞击点的虚拟 ROM 与实验测量的初始 ROM 之间的差异被称为软组织限制。结果表明，在包含高外展伴屈曲、高屈曲伴内收和内旋的运动中，正常髋关节存在骨性撞击。在无撞击运动中，软组织限制的程度差异很大，从屈曲 90°时的 4.9°±3.8°（内旋）到最大伸展时的 80.0°±12.5°（内旋）。这些发现揭示了在不同运动中骨骼和软组织对髋关节运动的相对贡献，有助于更好地理解不同目的的体格检查，以诊断骨骼或软组织相关疾病。
