Audenaert E A, Duquesne K, De Roeck J, Mutsvangwa T, Borotikar B, Khanduja V, Claes P
Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium.
Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
J Hip Preserv Surg. 2021 Feb 8;7(4):677-687. doi: 10.1093/jhps/hnab004. eCollection 2020 Dec.
The risk for ischiofemoral impingement has been mainly related to a reduced ischiofemoral distance and morphological variance of the femur. From an evolutionary perspective, however, there are strong arguments that the condition may also be related to sexual dimorphism of the pelvis. We, therefore, investigated the impact of gender-specific differences in anatomy of the ischiofemoral space on the ischiofemoral clearance, during static and dynamic conditions A random sampling Monte-Carlo experiment was performed to investigate ischiofemoral clearance during stance and gait in a large ( = 40 000) virtual study population, while using gender-specific kinematics. Subsequently, a validated gender-specific geometric morphometric analysis of the hip was performed and correlations between overall hip morphology (statistical shape analysis) and standard discrete measures (conventional metric approach) with the ischiofemoral distance were evaluated. The available ischiofemoral space is indeed highly sexually dimorphic and related primarily to differences in the pelvic anatomy. The mean ischiofemoral distance was 22.2 ± 4.3 mm in the females and 29.1 ± 4.1 mm in the males and this difference was statistically significant ( < 0.001). Additionally, the ischiofemoral distance was observed to be a dynamic measure, and smallest during femoral extension, and this in turn explains the clinical sign of pain in extension during long stride walking. In conclusion, the presence of a reduced ischiofemroal distance and related risk to develop a clinical syndrome of ischiofemoral impingement is strongly dominated by evolutionary effects in sexual dimorphism of the pelvis. This should be considered when female patients present with posterior thigh/buttock pain, particularly if worsened by extension. Controlled laboratory study.
坐骨股骨撞击的风险主要与坐骨股骨间距减小和股骨形态变异有关。然而，从进化的角度来看，有充分的理由认为这种情况也可能与骨盆的性别二态性有关。因此，我们研究了坐骨股骨间隙解剖结构的性别差异在静态和动态条件下对坐骨股骨间隙的影响。进行了一项随机抽样蒙特卡洛实验，以研究在一个大型（n = 40000）虚拟研究人群中站立和步态期间的坐骨股骨间隙，同时使用性别特异性运动学。随后，对髋关节进行了经过验证的性别特异性几何形态计量分析，并评估了整体髋关节形态（统计形状分析）和标准离散测量（传统度量方法）与坐骨股骨间距之间的相关性。可用的坐骨股骨间隙确实具有高度的性别二态性，并且主要与骨盆解剖结构的差异有关。女性的平均坐骨股骨间距为22.2±4.3毫米，男性为29.1±4.1毫米，这种差异具有统计学意义（P < 0.001）。此外，观察到坐骨股骨间距是一个动态测量值，在股骨伸展时最小，这反过来解释了大步行走时伸展时疼痛的临床症状。总之，坐骨股骨间距减小以及发生坐骨股骨撞击临床综合征的相关风险在很大程度上受骨盆性别二态性进化效应的支配。当女性患者出现大腿后部/臀部疼痛时，尤其是在伸展时加重的情况下，应考虑这一点。对照实验室研究。
