於X光及MRI觀測股骨形態特徵之方法探討並評估台灣志願者影像中具有股骨髖臼夾擠症陽性徵象之比率

Studing the Methods for Assessing Morphologic Features of Femur on X-ray and MRI and Evaluating the Percentage of Taiwanese Volunteers with Positive Femoroacetabular Impingement Signs in Images

郭勁良(Chin-Liang Kuo)

指導教授 ： 陳建宏

中山醫學大學/醫學科技學院/物理治療學系碩士班/碩士(2018年)

摘要

背景與目的:股骨髖臼夾擠症(Femoroacetabular Impingement, FAI)係指因髖關節結構異常而導致股骨頸經常撞擊到髖臼並引發骨性關節炎的現象。本研究旨在瞭解台灣志願者在影像中呈現FAI徵象之比率，並且發展更合適的測量方式，以利於此症的診斷和治療。
材料與方法:本研究分別使用傳統量角器及新提出的影像學方法量測髖關節內轉角度，並比較兩者在重複試驗上之差異。接著使用慣用的同心圓模板及自行開發出的數值分析法來量測頭-頸α角，並探討兩方法之一致性及相關性。上述評估工具與測量方法建立後，接著進行FAI比率分析。2015年12月至2017年5月間，於某區域醫院接受健康檢查之20至40歲潛在個案，經說明後志願並完成全部檢查之受測者共有160位。受測者皆進行髖部核磁共振造影及前後側(AP-view)與Dunn-view X光片攝影，並接受物理治療師之特殊測試檢查。
結果:重複試驗顯示，使用影像學測量髖內轉角度之結果與量角器無顯著差異，但標準差較小；由不同施測者施測也顯示影像學數據較為平穩。使用數值分析法與同心圓模板評估α角之結果不一致，但具有高度相關性(於X-ray或MRI影像中施測，r值分別為0.769(p<0.001)以及0.816(p<0.001))。使用數值分析法在X-ray或MRI施測，測試者間信度分別為0.855及0.980，測試者內信度分別為0.954及0.819。影像學檢查發現，全部志願者中，受測者至少一側髖部呈現cam-、pincer-或mixed-type FAI徵象之比率分別為34.4%(55/160)、61.9%(99/160)、及18.8%(30/160)。理學檢查發現，FAI個案在內轉、屈曲、及外展之被動關節活動度明顯低於正常人。特殊測試方面均未達鑑別能力。
結論與建議:本研究所提出的影像學方法和數值分析方法，在評估髖關節內轉角度以及α角具有很好的信效度和穩定性。透過影像的拍攝，可以將受測者當下的狀態記錄下來並重新檢視和測量。在FAI比率方面，我國人在cam-type及mixed-type FAI與日本人接近；不過在pincer-type的比率卻較高，以至於總比率達75.6%。另外，本研究認為，使用徒手做特殊測試檢查無法有效鑑別FAI，仍需搭配X-ray攝影進行篩檢。

關鍵字

股骨髖臼夾擠症 ； α角 ； 數值分析法

並列摘要

Background and Purpose: Femoroacetabular Impingement (FAI) is a phenomenon in which abnormal structure of hip joint causes femoral neck to frequently impinge the acetabulum and induce osteoarthritis. The purpose of this study was to evaluate the percentage of Taiwanese volunteers with positive signs of FAI in images, as well as to develop a more suitable measurement method, to facilitate the diagnosis and treatment of this disease.
Materials and Methods: This study used traditional protractor and the newly proposed imaging method, respectively, to measure the hip internal rotation angle, and compared the differences between these two methods in repeated test. Afterwards, this study used concentric circle template that is frequently used and the self-developed numerical method to measure the head-neck α angle, and investigated the consistency and correlation between these two methods. After the aforesaid evaluation tools and measurement methods were established, this study analyzed the percentage of FAI. From December 2015 to May 2017, the researcher explained this study to the young adults (aged 20 to 40) receiving health examination in a regional hospital, and a total of 160 subjects volunteered to participate in and completed all the examination items. All of the subjects received the MRI and X-ray AP-view and Dunn-view scans of the hip, and received the special tests performed by the physical therapist.
Results: The repeated test showed that there was no significant difference in the results of hip internal rotation angle measured using imaging method and protractor. However, the standard deviation of the result using imaging method was smaller. The measurement results by different operators also showed that the data of imaging method were more stable. The result of α angle evaluated by numerical method was inconsistent with that of using concentric circle template; however, there was a high correlation between them (r value was 0.769 (p<0.001) and 0.816 (p<0.001) in the X-ray and MRI, respectively). The inter-rater reliability of X-ray and MRI performed using numerical method was 0.855 and 0.980, respectively. The intra-rater reliability was 0.954 and 0.819, respectively. Results showed that, in all volunteers, the percentages of subject having at least one hip with positive cam-, pincer-, or mixed-type FAI sign in images were 34.4%(55/160), 61.9%(99/160), and 18.8%(30/160), respectively.The physical examination found that the passive joint activities of internal rotation, flexion, and abduction of patients with FAI were significantly lower than those of normal people. The special tests all did not reach an identification rate.
Conclusion and Suggestions: The imaging method and numerical analysis method proposed in this study showed very good reliability, validity, and stability in the evaluation of hip joint internal rotation angle and α angle. The shooting of images recorded the state of the subjects at the time and enabled the researcher to perform the inspection and measurement again. The percentages of cam-type and mixed-type FAI in people in Taiwan are similar to that in Japanese. However, the percentage of pincer-type in Taiwan is higher, with a total prevalence reaching 75.6%. Moreover, this study suggested that the use of special manual test could not effectively identify FAI and X-ray scan is still required for screening.

並列關鍵字

Femoroacetabular Impingement ； α Angle ； Numerical Method

參考文獻

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