Nowacki Rélana M E, Air Mary E, Rietveld A B M
Maastricht University Medical Center, 6224 CE Maastricht, The Netherlands.
Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA.
J Dance Med Sci. 2012 Sep;16(3):126-32.
Hyperpronation is a common finding when examining the dancer-patient and is thought to be implicated in several dance-related injuries. Little is known about the incidence of hyperpronation-related symptoms in dancers. Additionally, there is no current easy method for estimating the degree of hyperpronation. This study was designed to investigate the incidence of symptoms related to foot hyperpronation in dancer-patients and to evaluate the potential correlation between the patient's calcaneal angle and severity of hyperpronation. A retrospective study of 2,427 dancers' charts over the past 6 years was undertaken to identify dancers who presented with musculoskeletal complaints or problems related to hyperpronation. Physical exam data and diagnoses were collected. Among 24 new dancer-patients presenting to clinic with hyperpronation-related symptoms, the calcaneal angle was measured and correlated with a clinical grading scale based on the Hübscher maneuver. Per chart review, the incidence of symptomatic hyperpronation resulting in prescription for orthotics was 30% (739 dancers out of 2,427). The most common related diagnosis was retropatellar chondropathy (10%). Clinical severity of hyperpronation was linearly related to the calcaneal angle (95% CI [1.25, 4.14], p = 0.0006; Pearson's r(2) = 0.97). The calcaneal angles among mild, moderate, and severe hyperpronators differed significantly (H = 13.45, p = 0.0012). It was concluded that measuring the calcaneal angle may be a useful adjunct to the Hübscher maneuver for grading the clinical severity of a dancer's hyperpronation. Healthcare providers working with dancers should be aware of the presence of hyperpronation, its relation to compensatory turnout techniques, and association with injuries in the foot, ankle, knee, hip, and low back. A standard, time-efficient method of measuring and grading hyperpronation is still needed.
在检查舞蹈演员患者时，过度内旋是常见现象，被认为与多种舞蹈相关损伤有关。目前对于舞蹈演员中与过度内旋相关症状的发生率了解甚少。此外，目前尚无简单方法来估计过度内旋的程度。本研究旨在调查舞蹈演员患者中与足部过度内旋相关症状的发生率，并评估患者跟骨角度与过度内旋严重程度之间的潜在相关性。对过去6年中2427名舞蹈演员的病历进行回顾性研究，以确定出现肌肉骨骼问题或与过度内旋相关问题的舞蹈演员。收集体格检查数据和诊断结果。在24名因过度内旋相关症状前来诊所就诊的新舞蹈演员患者中，测量了跟骨角度，并将其与基于许布施 maneuver 的临床分级量表相关联。通过病历审查，因有症状的过度内旋而开具矫形器处方的发生率为30%（2427名舞蹈演员中有739名）。最常见的相关诊断是髌后软骨病（10%）。过度内旋的临床严重程度与跟骨角度呈线性相关（95%可信区间[1.25, 4.14]，p = 0.0006；Pearson相关系数r(2) = 0.97）。轻度、中度和重度过度内旋者的跟骨角度差异显著（H = 13.45，p = 0.0012）。研究得出结论，测量跟骨角度可能是许布施 maneuver 的有用辅助手段，用于对舞蹈演员过度内旋的临床严重程度进行分级。与舞蹈演员合作的医疗保健提供者应意识到过度内旋的存在、其与代偿性外转技术的关系以及与足部、踝关节、膝关节、髋关节和下背部损伤的关联。仍然需要一种标准、高效的测量和分级过度内旋的方法。
