Agnvall Cecilia, Swärd Aminoff Anna, Todd Carl, Jonasson Pall, Thoreson Olof, Swärd Leif, Karlsson Jon, Baranto Adad
Sportsmedicine Åre and Åre Ski High School, Åre, Sweden.
Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.
Orthop J Sports Med. 2017 Jun 28;5(6):2325967117711890. doi: 10.1177/2325967117711890. eCollection 2017 Jun.
Radiologically verified cam-type femoroacetabular impingement (FAI) has been shown to correlate with reduced internal rotation, reduced passive hip flexion, and a positive anterior impingement test.
To validate how a clinical examination of the hip joint correlates with magnetic resonance imaging (MRI)-verified cam deformity in adolescents.
Cross-sectional study; Level of evidence, 3.
The sample group consisted of 102 adolescents with the mean age 17.7 ± 1.4 years. The hip joints were examined using MRI for measurements of the presence of cam (α-angle ≥55°) and clinically for range of motion (ROM) in both supine and sitting positions. The participants were divided into a cam and a noncam group based on the results of the MRI examination. Passive hip flexion, internal rotation, anterior impingement, and the FABER (flexion, abduction, and external rotation) test were used to test both hips in the supine position. With the participant sitting, the internal/external rotation of the hip joint was measured in 3 different positions of the pelvis (neutral, maximum anteversion, and retroversion) and lumbar spine (neutral, maximum extension, and flexion).
Differences were found between the cam and noncam groups in terms of the anterior impingement test (right, = .010; left, = .006), passive supine hip flexion (right: mean, 5°; cam, 117°; noncam, 122° [ = .05]; and left: mean, 8.5°; cam, 116°; noncam, 124.5° [ = .001]), supine internal rotation (right: mean, 4.9°; cam, 24°; noncam, 29° [ = .022]; and left: mean, 4.8°; cam, 26°; noncam, 31° [ = .028]), sitting internal rotation with the pelvis and lumbar spine in neutral (right: mean, 7.95°; cam, 29°; noncam, 37° [ = .001]; and left: mean, 6.5°; cam, 31.5°; noncam, 38° [ = .006]), maximum anteversion of the pelvis and extension of the lumbar spine (right: mean, 5.2°; cam, 20°; noncam, 25° [ = .004]; and left: mean, 5.85°; cam, 20.5; noncam, 26.4° [ = .004]), and maximum retroversion of the pelvis and flexion of the spine (right: mean, 8.4°; cam, 32.5°; noncam, 41° [ = .001]; and left: mean, 6.2°; cam, 36°; noncam, 42.3° [ = .012]). The cam group had reduced ROM compared with the noncam group in all clinical ROM measures.
The presence of cam deformity on MRI correlates with reduced internal rotation in the supine and sitting positions, passive supine hip flexion, and the impingement test in adolescents.
经放射学证实的凸轮型股骨髋臼撞击症（FAI）已被证明与内旋减少、被动髋关节屈曲减少以及前撞击试验阳性相关。
验证青少年髋关节的临床检查与磁共振成像（MRI）证实的凸轮畸形之间的相关性。
横断面研究；证据水平，3级。
样本组由102名平均年龄为17.7±1.4岁的青少年组成。使用MRI检查髋关节，以测量凸轮的存在情况（α角≥55°），并在仰卧位和坐位进行临床运动范围（ROM）检查。根据MRI检查结果将参与者分为凸轮组和非凸轮组。在仰卧位使用被动髋关节屈曲、内旋、前撞击试验以及FABER（屈曲、外展和外旋）试验对双侧髋关节进行检查。参与者坐位时，在骨盆的3个不同位置（中立位、最大前倾位和后倾位）以及腰椎的3个不同位置（中立位、最大伸展位和屈曲位）测量髋关节的内/外旋。
凸轮组和非凸轮组在前撞击试验（右侧，P = 0.010；左侧，P = 0.006）、被动仰卧位髋关节屈曲（右侧：平均值，5°；凸轮组，117°；非凸轮组，122°[P = 0.05]；左侧：平均值，8.5°；凸轮组，116°；非凸轮组，124.5°[P = 0.001]）、仰卧位内旋（右侧：平均值，4.9°；凸轮组，24°；非凸轮组，29°[P = 0.022]；左侧：平均值，4.8°；凸轮组，26°；非凸轮组，31°[P = 0.028]）、骨盆和腰椎处于中立位时的坐位内旋（右侧：平均值，7.95°；凸轮组，29°；非凸轮组，37°[P = 0.001]；左侧：平均值，6.5°；凸轮组，31.5°；非凸轮组，38°[P = 0.006]）、骨盆最大前倾位和腰椎伸展位（右侧：平均值，5.2°；凸轮组，20°；非凸轮组，25°[P = 0.004]；左侧：平均值，5.85°；凸轮组，20.5°；非凸轮组，26.4°[P = 0.004]）以及骨盆最大后倾位和脊柱屈曲位（右侧：平均值，8.4°；凸轮组，32.5°；非凸轮组，41°[P = 0.001]；左侧：平均值，6.2°；凸轮组，36°；非凸轮组，42.3°[P = 0.012]）方面存在差异。在所有临床ROM测量中，凸轮组的ROM均低于非凸轮组。
MRI上凸轮畸形的存在与青少年仰卧位和坐位时的内旋减少、被动仰卧位髋关节屈曲以及撞击试验相关。
