Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, Kyungki, South Korea.
J Bone Joint Surg Am. 2010 May;92(5):1195-205. doi: 10.2106/JBJS.I.00688.
Increased femoral anteversion and coxa valga are common in patients with cerebral palsy. The purpose of the present study was to determine the validity and reliability of the methods that are commonly used to measure the proximal femoral geometry in patients with cerebral palsy.
Thirty-six consecutive patients (mean age, eleven years; range, five to twenty years) with cerebral palsy were enrolled in the present study. The validity and the interobserver reliability of the physical examinations performed by three examiners were determined by comparing the results of a trochanteric prominence angle test, hip internal rotation measurements, and hip external rotation measurements (all with the patient in the prone position) with the amount of femoral anteversion on two-dimensional computed tomography. Validity and intraobserver and interobserver reliability were assessed by comparing the neck-shaft angle on the anteroposterior internal rotation radiograph of the hips with that on the multiplanar reformatted computed tomographic image.
The trochanteric prominence angle test showed excellent concurrent validity (R = 0.862, p < 0.001) and reliability (intraclass correlation coefficient, 0.809). Hip internal rotation also showed good concurrent validity (R = 0.787, p < 0.001) and excellent reliability (intraclass correlation coefficient, 0.889), whereas hip external rotation appeared to be unsuitable for predicting femoral anteversion. The neck-shaft angle on the anteroposterior internal rotation radiograph of the hips showed excellent concurrent validity (R = 0.892, p < 0.001) and reliability (intraclass correlation coefficient, 0.912).
A physical examination for determining femoral anteversion and the neck-shaft angle as measured on the internal rotation radiograph of the hips appear to be clinically relevant methods for evaluating the proximal femoral geometry and version in patients with cerebral palsy. Computed tomographic examination can probably be replaced by physical examination and an anteroposterior internal rotation radiograph of the hips for patients with stable hips who are able to walk.
股骨前倾角增大和髋外翻在脑瘫患者中很常见。本研究旨在确定目前用于测量脑瘫患者股骨近端几何形状的常用方法的有效性和可靠性。
本研究纳入了 36 例连续脑瘫患者（平均年龄 11 岁；范围为 5 至 20 岁）。通过比较三种检查者进行的转子突出角试验、髋关节内旋测量和髋关节外旋测量（所有患者均处于俯卧位）的结果与二维计算机断层扫描上的股骨前倾角，确定了体格检查的有效性和观察者间可靠性。通过比较髋关节前后内旋射线照片上的颈干角与多平面重建 CT 图像上的颈干角，评估了颈干角的内、观察者间可靠性。
转子突出角试验具有极好的同期有效性（R = 0.862，p < 0.001）和可靠性（组内相关系数为 0.809）。髋关节内旋也具有良好的同期有效性（R = 0.787，p < 0.001）和极好的可靠性（组内相关系数为 0.889），而髋关节外旋似乎不适合预测股骨前倾角。髋关节前后内旋射线照片上的颈干角具有极好的同期有效性（R = 0.892，p < 0.001）和可靠性（组内相关系数为 0.912）。
用于确定股骨前倾角的体格检查以及髋关节内旋射线照片上的颈干角似乎是评估脑瘫患者股骨近端几何形状和前倾角的临床相关方法。对于能够行走且髋关节稳定的患者，CT 检查可能可以被体格检查和髋关节前后内旋射线照片取代。
