Kayal Orthopaedic Center, Westwood, New Jersey, USA.
American Hip Institute Research Foundation, Chicago, Illinois, USA.
Am J Sports Med. 2022 Jan;50(1):40-49. doi: 10.1177/03635465211056086. Epub 2021 Nov 26.
Sex differences are frequently encountered when diagnosing orthopaedic problems. Current literature suggests specific sex differences, such as a higher prevalence of cam-type femoroacetabular impingement syndrome in male patients and features of hip instability in female patients.
To identify hip pathology patterns according to sex, alpha angle deformity, and generalized ligamentous laxity (GLL) in a nonarthritic patient population that underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome and labral tears.
Cross-sectional study; Level of evidence, 3.
Patients who underwent primary hip arthroscopy between February 2008 and February 2017 were included and separated into male and female groups for initial analysis. Patients were excluded if they had Tönnis osteoarthritis grade >1, previous ipsilateral hip surgery, or previous hip conditions. The demographics, radiographic findings, intraoperative findings, and surgical procedures were then analyzed and compared. Subanalyses were performed for both groups. A threshold of 1 SD above the mean alpha angle in the male group was used to create 2 subgroups. For female patients, GLL based on a Beighton score ≥4 was used to divide the group. Intraoperative findings were compared for both subanalyses.
A total of 2701 hips met all inclusion and exclusion criteria. Of those, 994 hips were in the male group and 1707 in the female group. The mean ± SD age was 36.6 ± 13.8 and 37.1 ± 15.0 years for the male and female groups, respectively( = .6288). The average body mass index was significantly higher in the male group ( < .0001). GLL was more common in women (38.6%) than men (13.6%) ( < .001). The male group had a higher proportion of acetabular Outerbridge grade 3 (21.8%) and 4 (19.2%) lesions when compared with the female group (9.3% and 6.3%, respectively) ( < .0001). Men in the subgroup with an alpha angle ≥78° reported higher rates of acetabular Outerbridge grade 4 damage than men with an alpha angle <78° ( < .001). Mean lateral center-edge angle was lower in the female subgroup with Beighton score ≥4 vs <4 (23.7°± 4.2° vs 31.3°± 5.8°; < .0001).
In this analysis of a large cohort of patients who underwent hip arthroscopy, 2 patterns of hip pathologies were related to sex. On average, male patients had larger alpha angles and increased acetabular chondral damage when compared with their female counterparts. Furthermore, a larger cam-type anatomy was associated with more severe acetabular chondral damage in men. In the female group, the incidence of features of hip instability such as GLL were significantly higher than in the male group.
在诊断骨科问题时，经常会出现性别差异。目前的文献表明存在特定的性别差异，例如男性患者中凸轮型股骨髋臼撞击综合征的患病率较高，女性患者中髋关节不稳定的特征。
在患有股骨髋臼撞击综合征和盂唇撕裂的非关节炎患者人群中，根据性别、阿尔法角畸形和广义韧带松弛（GLL）识别髋关节病理模式，这些患者接受了初次髋关节镜检查。
横断面研究；证据水平，3 级。
纳入 2008 年 2 月至 2017 年 2 月期间接受初次髋关节镜检查的患者，并将其分为男性和女性组进行初步分析。如果患者存在 Tönnis 骨关节炎分级>1 级、同侧髋关节手术史或先前存在髋关节疾病，则将其排除在外。然后分析和比较患者的人口统计学、影像学发现、术中发现和手术程序。对两组均进行亚组分析。使用男性组中阿尔法角平均值加 1 个标准差创建了 2 个子组。对于女性患者，使用 Beighton 评分≥4 的 GLL 将其分组。比较了两个亚组的术中发现。
共有 2701 个髋关节符合所有纳入和排除标准。其中，994 个髋关节在男性组，1707 个在女性组。男性组的平均年龄±标准差为 36.6±13.8 岁，女性组为 37.1±15.0 岁（=0.6288）。男性组的平均体重指数明显更高（<0.0001）。女性中 GLL 的发生率（38.6%）明显高于男性（13.6%）（<0.001）。与女性组相比，男性组髋臼外侧壁 3 级（21.8%）和 4 级（19.2%）病变的比例更高（分别为 9.3%和 6.3%）（<0.0001）。阿尔法角≥78°的男性亚组报告髋臼外侧壁 4 级损伤的比例高于阿尔法角<78°的男性亚组（<0.001）。女性亚组 Beighton 评分≥4 与<4 的平均外侧中心边缘角较低（分别为 23.7°±4.2°和 31.3°±5.8°；<0.0001）。
在这项对接受髋关节镜检查的大量患者的分析中，两种髋关节病变模式与性别有关。平均而言，与女性相比，男性的阿尔法角更大，髋臼软骨损伤更严重。此外，男性中凸轮型解剖结构与更严重的髋臼软骨损伤相关。在女性组中，GLL 等髋关节不稳定特征的发生率明显高于男性组。
