使用新型灵活性夹具测量僵硬拇趾的关节灵活性。
Measuring Joint Flexibility in Hallux Rigidus Using a Novel Flexibility Jig.
作者信息
Cody Elizabeth A, Kraszewski Andrew P, Marinescu Anca, Kunas Grace C, Mani Sriniwasan B, Rao Smita, Hillstrom Howard H, Ellis Scott J
机构信息
1 Hospital for Special Surgery, New York, NY, USA.
2 Georgetown University School of Medicine, Washington, DC, USA.
出版信息
Foot Ankle Int. 2017 Aug;38(8):885-892. doi: 10.1177/1071100717709538. Epub 2017 May 23.
BACKGROUND
The flexibility of the first metatarsophalangeal (MTP) joint in patients with hallux rigidus (HR) has not been studied. Compared to measuring range of motion alone, measures of joint flexibility provide additional information that may prove useful in the assessment of HR. The purpose of this study was to assess the flexibility of the hallux MTP joint in patients with HR compared to controls using a novel flexibility device.
METHODS
Fifteen patients with Coughlin stage II or III HR and 20 healthy controls were recruited prospectively. Using a custom flexibility jig, each of 2 raters performed a series of seated and standing tests on each subject. Dorsiflexion angle and applied torque were plotted against each other to generate 5 different parameters of flexibility. Differences between (1) HR patients and controls and (2) the sitting and standing testing positions were assessed with t tests. Intrarater test-retest reliability, remove-replace reliability, and interrater reliability were assessed with intraclass correlation coefficients (ICCs).
RESULTS
Patients in the HR group were older than patients in the control group ( P < .001) and had lower maximum dorsiflexion ( P < .001). HR patients were less flexible as measured by 3 of the 5 flexibility parameters: early flexibility (first 25% of motion; P = .027), laxity angle ( P < .001), and torque angle ( P = .002). After controlling for age, only laxity angle differed significantly between HR patients and controls ( P < .001). Generally, patients were more flexible when seated compared to standing, with this effect being more marked in HR patients. All parameters had good or excellent intra- and interrater reliability (ICC ≥ 0.60).
CONCLUSIONS
Hallux MTP joint flexibility was reliably assessed in HR patients using a flexibility device. Patients with HR had decreased flexibility of the hallux MTP joint compared to control patients.
LEVEL OF EVIDENCE
Level II, prospective comparative study.
背景
僵硬性拇趾（HR）患者第一跖趾（MTP）关节的灵活性尚未得到研究。与仅测量活动范围相比，关节灵活性测量提供了额外信息，这可能在HR评估中证明有用。本研究的目的是使用一种新型灵活性装置，评估HR患者与对照组相比拇趾MTP关节的灵活性。
方法
前瞻性招募了15例Coughlin II期或III期HR患者和20名健康对照者。使用定制的灵活性夹具，两名评估者分别对每个受试者进行一系列坐位和站立测试。将背屈角度和施加的扭矩相互绘制以生成5个不同的灵活性参数。使用t检验评估（1）HR患者与对照组之间以及（2）坐位和站立测试位置之间的差异。使用组内相关系数（ICC）评估评估者内重测信度、去除-替换信度和评估者间信度。
结果
HR组患者比对照组患者年龄更大（P < .001），最大背屈更低（P < .001）。通过5个灵活性参数中的3个测量，HR患者的灵活性较低：早期灵活性（运动的前25%；P = .027）、松弛角度（P < .001）和扭矩角度（P = .002）。在控制年龄后，HR患者与对照组之间仅松弛角度存在显著差异（P < .001）。一般来说，患者坐位时比站立时更灵活，这种效应在HR患者中更明显。所有参数在评估者内和评估者间均具有良好或优秀的信度（ICC≥0.60）。
结论
使用灵活性装置可可靠地评估HR患者的拇趾MTP关节灵活性。与对照患者相比，HR患者的拇趾MTP关节灵活性降低。
证据水平
II级，前瞻性比较研究。
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