Maier Claudia, Zingg Patrick, Seifert Burkhardt, Sutter Reto, Dora Claudio
Department of Orthopaedics, University of Zurich, Uniklinik Balgrist, Forchstrasse 340, Zurich, Switzerland.
Hip Int. 2012 Sep-Oct;22(5):534-8. doi: 10.5301/HIP.2012.9352.
Influence of femoral torsion on femoroacetabular impingement and other hip conditions is not well documented and its assessment by imaging methods during clinical work-up is not routinely performed. We studied whether physical examination could reliably measure or at least screen for gross anomalies of femoral torsion or if appropriate imaging should routinely be performed. Assessing femoral torsion of 45 volunteers using the "trochanteric prominence angle test" and magnetic resonance imaging (MRI), inter- and intra-observer reliability ranged from poor to moderate and agreement with MRI values was only fair. Considering a 5° to 10° difference of femoral torsion as clinically relevant, physical examination failed to match MRI values within ±10° in more than 50%. Arbitrarily defining thresholds for pathological femoral torsion, the "trochanteric prominence angle test" could not recognise torsions outside the >30°/<0° range and diagnosed torsions outside the >20°/<10° range with a sensitivity of 18%-75% and a specificity of 58%-98% only. Physical assessment of femoral torsion using the "trochanteric prominence angle test" does not allow reliable measurement or screening for gross anomalies. We therefore integrate an adapted MRI protocol allowing measurement of femoral torsion within our clinical work up.
股骨扭转对股骨髋臼撞击及其他髋关节疾病的影响尚无充分文献记载，在临床检查过程中，通过影像学方法对其进行评估也未常规开展。我们研究了体格检查能否可靠地测量或至少筛查出股骨扭转的明显异常，或者是否应常规进行适当的影像学检查。使用“转子突出角试验”和磁共振成像（MRI）对45名志愿者的股骨扭转进行评估，观察者间和观察者内的可靠性从差到中等，与MRI值的一致性仅为一般。将股骨扭转5°至10°的差异视为具有临床相关性，超过50%的体格检查结果在±10°范围内未能与MRI值匹配。任意定义病理性股骨扭转的阈值，“转子突出角试验”无法识别超过30°/＜0°范围外的扭转，对于超过20°/＜10°范围外的扭转，其诊断的敏感性仅为18% - 75%，特异性为58% - 98%。使用“转子突出角试验”对股骨扭转进行体格评估无法可靠地测量或筛查出明显异常。因此，我们在临床检查中纳入了一种改良的MRI方案，以允许测量股骨扭转。
