Boschung Adam, Antioco Tiziano, Steppacher Simon D, Tannast Moritz, Novais Eduardo N, Kim Young-Jo, Lerch Till D
Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland.
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Orthop J Sports Med. 2023 Jul 25;11(7):23259671231184802. doi: 10.1177/23259671231184802. eCollection 2023 Jul.
The location of posterior hip impingement at maximal extension in patients with posterior femoroacetabular impingement (FAI) is unclear.
To investigate the frequency and area of impingement at maximal hip extension and at 10° and 20° of extension in female patients with increased femoral version (FV) and posterior hip pain.
Cross-sectional study; Level of evidence, 3.
Osseous patient-specific 3-dimensional (3D) models were generated of 50 hips (37 female patients, 3D computed tomography) with a positive posterior impingement test and increased FV (defined as >35°). The McKibbin index (combined version) was calculated as the sum of FV and acetabular version (AV). Subgroups of patients with an increased McKibbin index >70° (24 hips) and FV >50° (20 hips) were analyzed. A control group of female participants (10 hips) had normal FV, normal AV, and no valgus deformity (neck-shaft angle, <139°). Validated 3D collision detection software was used for simulation of osseous impingement-free hip extension (no rotation).
The mean impingement-free maximal hip extension was significantly lower in patients with FV >35° compared with the control group (15° ± 15° vs 55° ± 19°; < .001). At maximal hip extension, 78% of patients with FV >35° had osseous posterior extra-articular ischiofemoral hip impingement. At 20° of extension, the frequency of posterior extra-articular ischiofemoral impingement was significantly higher for patients with a McKibbin index >70° (83%) and for patients with FV >35° (76%) than for controls (0%) ( < .001 for both). There was a significant correlation between maximal extension (no rotation) and FV ( = 0.46; < .001) as well as between impingement area at 20° of extension (external rotation [ER], 0°) and McKibbin index (0.61; < .001). Impingement area at 20° of extension (ER, 0°) was significantly larger for patients with McKibbin index >70° versus <70° (251 vs 44 mm; = .001).
The limited hip extension found in our study could theoretically affect the performance of sports activities such as running, ballet dancing, or lunges. Therefore, although not examined directly in this study, these activities are not advisable for these patients. Preoperative evaluation of FV and the McKibbin index is important in female patients with posterior hip pain before hip preservation surgery (eg, hip arthroscopy).
股骨髋臼撞击症（FAI）患者在最大伸展位时后髋关节撞击的位置尚不清楚。
研究股骨颈前倾角（FV）增大且有后髋关节疼痛的女性患者在髋关节最大伸展位、伸展10°和20°时撞击的频率和区域。
横断面研究；证据等级，3级。
对50例髋关节（37例女性患者，采用三维计算机断层扫描）进行了特定患者的骨三维（3D）模型构建，这些患者后撞击试验阳性且FV增大（定义为>35°）。计算McKibbin指数（联合版本），即FV与髋臼前倾角（AV）之和。分析了McKibbin指数>70°（24例髋关节）和FV>50°（20例髋关节）的患者亚组。一组女性对照参与者（10例髋关节）的FV、AV均正常，且无外翻畸形（颈干角，<139°）。使用经过验证的3D碰撞检测软件模拟无骨撞击的髋关节伸展（无旋转）。
FV>35°的患者无撞击的平均最大髋关节伸展度显著低于对照组（15°±15° vs 55°±19°；P<.001）。在髋关节最大伸展位时，FV>35°的患者中有78%发生了后关节外坐骨股骨撞击。在伸展20°时，McKibbin指数>70°的患者（83%）和FV>35°的患者（76%）后关节外坐骨股骨撞击的频率显著高于对照组（0%）（两者P均<.001）。最大伸展度（无旋转）与FV之间存在显著相关性（r=0.46；P<.001），伸展20°时的撞击面积（外旋[ER]，0°）与McKibbin指数之间也存在显著相关性（r=0.61；P<.001）。McKibbin指数>70°的患者在伸展20°时（ER，0°）的撞击面积显著大于<70°的患者（251 vs 44 mm²；P=.001）。
我们研究中发现髋关节伸展受限理论上可能会影响跑步、芭蕾舞或弓步等体育活动的表现。因此，尽管本研究未直接对此进行检测，但这些活动对这些患者并不可取。在进行保髋手术（如髋关节镜检查）前，对FV和McKibbin指数进行术前评估对有后髋关节疼痛的女性患者很重要。
