Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, México, DF, Mexico.
Unidad de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Yucatán, Mexico.
Clin Rheumatol. 2017 Dec;36(12):2813-2819. doi: 10.1007/s10067-017-3702-x. Epub 2017 Jun 1.
This study aimed to generate a minimum list of structural and functional anatomical items about the pelvis/hip, knee, ankle/foot, gait, and lower limb innervation, which are most relevant to the practice of rheumatology. To determine their perceived relevance to clinical practice, seven members of the Mexican Clinical Anatomy Task Force compiled an initial list of 470 anatomical items. Ten local and international experts according to a 0-10 Likert scale ranked these items. Of the original list, 101 (21.48%) items were considered relevant (global rate >40). These included 36/137 (26.27%) pelvis and hip items, 25/82 (30.48%) knee items, 22/168 (13.98%) ankle/foot items, 11/68 (16.17%) neurologic items, and 7/15 (46.66%) gait-related items. We propose that these 101 anatomical items of the lower extremity, when added to the 115 anatomic items of the upper extremity and spine we previously reported, may represent an approximation to the minimal anatomical knowledge central to the competent practice of rheumatology. The meager representation of ankle and foot items may reflect a lesser emphasis in these anatomical regions during rheumatologic training. Attention to these and related items during rheumatologic training and beyond may sharpen the rheumatologist's ability in the differential diagnosis of regional pain syndromes as well as strengthen an endangered art: the rheumatologic physical examination.
本研究旨在生成一组关于骨盆/臀部、膝盖、脚踝/脚、步态和下肢神经支配的结构和功能解剖项目的最小清单,这些项目与风湿病学的实践最相关。为了确定它们对临床实践的感知相关性,墨西哥临床解剖学工作组的七名成员编制了一份最初包含 470 个解剖项目的清单。根据 0-10 级李克特量表,10 名当地和国际专家对这些项目进行了排名。在原始清单中,有 101 项(21.48%)被认为是相关的(全球评分>40)。其中包括 36/137(26.27%)骨盆和臀部项目、25/82(30.48%)膝盖项目、22/168(13.98%)脚踝/脚部项目、11/68(16.17%)神经项目和 7/15(46.66%)步态相关项目。我们建议,将这 101 项下肢解剖项目与我们之前报告的 115 项上肢和脊柱解剖项目相结合,可能代表了风湿病学熟练实践所需的最小解剖知识的近似值。踝关节和足部项目的代表不足可能反映了在风湿病学培训中这些解剖区域的重视程度较低。在风湿病学培训及以后,关注这些项目和相关项目可以提高风湿病学家对区域性疼痛综合征的鉴别诊断能力,并加强一项岌岌可危的艺术:风湿病学体格检查。