肩松弛度试验作为多向不稳定症的诊断标准的运动学和生物力学有效性。
Kinematics and biomechanical validity of shoulder joint laxity tests as diagnostic criteria in multidirectional instability.
机构信息
Divisions of Rehabilitation Science and Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States.
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States.
出版信息
Braz J Phys Ther. 2021 Nov-Dec;25(6):883-890. doi: 10.1016/j.bjpt.2021.10.001. Epub 2021 Nov 12.
BACKGROUND
Clinical laxity tests are commonly used together to identify individuals with multidirectional instability (MDI). However, their biomechanical validity in distinguishing distinct biomechanical characteristics consistent with MDI has not been demonstrated.
OBJECTIVE
To determine if differences in glenohumeral (GH) joint laxity exist between individuals diagnosed with multidirectional instability (MDI) and asymptomatic matched controls without MDI.
METHODS
Eighteen participants (9 swimmers with MDI, 9 non-swimming asymptomatic matched controls without MDI) participated in this observational study. Participants were classified as having MDI with a composite laxity score from three laxity tests (anterior/posterior drawer and sulcus tests). Single plane dynamic fluoroscopy captured joint motion with 2D-3D joint registration to derive 3D joint kinematics. Average GH translations occurring during the laxity tests were compared between groups using an independent sample's t-test. The relationship of composite laxity scores to overall translations was examined with a simple linear regression. Differences of each laxity test translation between groups were analyzed with a two-way repeated measures ANOVA.
RESULTS
Mean composite translations for swimmers were 1.7 mm greater (p = 0.04, 95% Confidence Interval (CI): 0.1, 3.3 mm) compared to controls. A moderate association occurred (r = 0.40, p = 0.005) between composite laxity scores and composite translation. Greater translations for the posterior drawer (-2.4 mm, p = 0.04, 95% CI: -0.1, -4.6) and sulcus tests (-2.7 mm, p = 0.03, 95% CI: -0.3, -5.0) existed in swimmers compared to controls.
CONCLUSION
Significant differences in composite translation existed between symptomatic swimmers with MDI and asymptomatic control participants without MDI during GH joint laxity tests. The results provide initial biomechanically based construct validity for the clinical criteria used to identify individuals with MDI.
背景
临床松弛度测试常用于识别多向不稳定（MDI）患者。然而，它们在区分与 MDI 一致的不同生物力学特征方面的生物力学有效性尚未得到证实。
目的
确定患有多向不稳定（MDI）的个体与无 MDI 的无症状匹配对照组之间的肩肱关节（GH）松弛度是否存在差异。
方法
18 名参与者（9 名患有 MDI 的游泳运动员，9 名无 MDI 的非游泳无症状匹配对照组）参加了这项观察性研究。参与者被分类为具有 MDI，其由三个松弛度测试（前/后抽屉和沟试验）组成的综合松弛度评分。单平面动态荧光透视术使用 2D-3D 关节配准捕获关节运动，以得出 3D 关节运动学。使用独立样本 t 检验比较组间松弛度测试中的平均 GH 平移。使用简单线性回归检查综合松弛度评分与整体平移的关系。使用双向重复测量方差分析分析组间每个松弛度测试平移的差异。
结果
与对照组相比，游泳运动员的平均综合平移量增加了 1.7 毫米（p=0.04，95%置信区间（CI）：0.1，3.3 毫米）。复合松弛度评分与复合平移之间存在中度关联（r=0.40，p=0.005）。游泳运动员的后抽屉（-2.4 毫米，p=0.04，95%CI：-0.1，-4.6）和沟试验（-2.7 毫米，p=0.03，95%CI：-0.3，-5.0）的平移量明显大于对照组。
结论
在 GH 关节松弛度测试中，患有 MDI 的有症状游泳运动员与无症状无 MDI 对照组参与者之间存在综合平移量的显著差异。这些结果为用于识别 MDI 患者的临床标准提供了初步的基于生物力学的结构有效性。
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