Purpose

In cases of suspected rotational deformity of the lower limb, in particular in post-traumatic malalignment following closed nailing, there is a lack of adequate reference values. Available publications on leg rotation have either small sample sizes or do not include bilateral or whole leg rotation of healthy legs. This study aimed to determine side-specific reference values of lower limb rotation in a large healthy sample. This may be helpful in acute clinical settings as well as for medical expert opinion.

Methods

226 consecutive bilateral lower limb computed tomography (CT) angiographies were screened. 105 patients (210 legs) were included (40 females, 65 males, mean age 67 ± 12 years). Bilateral axial femoral and tibial rotation alignment were independently measured and overall leg rotation was computed by two methods. Distributions, sex, and side differences were analyzed.

Results

Two-sided paired t tests showed significant differences between right and left for all measurements. The left side showed a more pronounced mean anteversion in the femur of 2.2° (p = 0.002) and the right side higher mean external rotation in the tibia of 2.8° (p < 0.001). Overall leg rotation showed 5.1° more mean external rotation on the right side (p < 0.001) with both methods. Absolute side-to-side whole leg rotation difference was 9.5°. Absolute differences between both methods were 3.3°. The variance was high. 23 femora were retroverted, 1 tibia internally rotated, and 9 legs were overall internally rotated. No variables differed between female and male subjects except for femoral version (right p = 0.003 and left p = 0.002). Correlation coefficients were high (rho 0.550–0.934, all p < 0.001).

Conclusion

There is a significant prevalence of side-to-side asymmetry in femoro-tibial torsion. Although side-to-side differences are not extraordinary, comparative axial femoro-tibial rotation alignment should always be interpreted with caution.

Level of evidence

Diagnostic, retrospective cohort study, level III.

中文翻译：

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双侧股胫腿旋转的个体内差异：105 名健康受试者的 CT 研究。

目的

在怀疑下肢旋转畸形的情况下，特别是在闭合钉后的创伤后排列不齐的情况下，缺乏足够的参考值。关于腿部旋转的现有出版物要么样本量小，要么不包括健康腿的双侧或全腿旋转。本研究旨在确定大型健康样本中下肢旋转的侧特定参考值。这可能有助于急性临床环境以及医学专家的意见。

方法

筛选了 226 个连续的双侧下肢计算机断层扫描 (CT) 血管造影。包括 105 名患者（210 条腿）（40 名女性，65 名男性，平均年龄 67 ± 12 岁）。双侧轴向股骨和胫骨旋转对齐是独立测量的，整体腿旋转通过两种方法计算。分析了分布、性别和侧面差异。

结果

两侧配对t检验显示所有测量值的右侧和左侧之间存在显着差异。左侧股骨平均前倾角为 2.2° ( p  = 0.002)，右侧胫骨平均外旋角为 2.8° ( p  < 0.001)。两种方法的整体腿部旋转显示右侧外旋平均多出 5.1° ( p  < 0.001)。绝对的左右全腿旋转差异为 9.5°。两种方法之间的绝对差异为 3.3°。方差很大。23股股骨后倾，1股胫骨内旋，9条腿整体内旋。除了股骨版本（右p = 0.003，左 p  = 0.002）。相关系数很高（rho 0.550–0.934，所有p  < 0.001）。

结论

在股胫扭转中，左右不对称的发生率很高。尽管左右差异并不特别，但应始终谨慎解释比较轴向股胫旋转对齐。

证据水平

诊断性、回顾性队列研究，III 级。