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Femoral anteversion: significance and measurement.
Journal of Anatomy ( IF 1.8 ) Pub Date : 2020-06-24 , DOI: 10.1111/joa.13249 Matteo Scorcelletti 1 , Neil D Reeves 1 , Jörn Rittweger 2, 3 , Alex Ireland 1
Journal of Anatomy ( IF 1.8 ) Pub Date : 2020-06-24 , DOI: 10.1111/joa.13249 Matteo Scorcelletti 1 , Neil D Reeves 1 , Jörn Rittweger 2, 3 , Alex Ireland 1
Affiliation
Femoral neck anteversion (FNA) is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Differences in FNA affect the biomechanics of the hip, through alterations in factors such as moment arm lengths and joint loading. Altered gait associated with differences in FNA may also contribute to the development of a wide range of skeletal disorders including osteoarthritis. FNA varies by up to 30° within apparently healthy adults. FNA increases substantially during gestation and thereafter decreases steadily until maturity. There is some evidence of a further decrease at a much lower rate during adulthood into old age, but the mechanisms behind it have never been studied. Development of FNA appears to be strongly influenced by mechanical forces experienced during everyday movements. This is evidenced by large differences in FNA in groups where movement is impaired, such as children born breech or individuals with neuromuscular conditions such as cerebral palsy. Several methods can be used to assess FNA, which may yield different values by up to 20° in the same participant. While MRI and CT are used clinically, limitations such as their cost, scanning time and exposure to ionising radiation limit their applicability in longitudinal and population studies, particularly in children. More broadly, applicable measures such as ultrasound and functional tests exist, but they are limited by poor reliability and validity. These issues highlight the need for a valid and reliable universally accepted method. Treatment for clinically problematic FNA is usually de‐rotational osteotomy; passive, non‐operative methods do not have any effect. Despite observational evidence for the effects of physical activity on FNA development, the efficacy of targeted physical activity remains unexplored. The aim of this review is to describe the biomechanical and clinical consequences of FNA, factors influencing FNA and the strengths and weaknesses of different methods used to assess FNA.
中文翻译:
股骨前倾角:意义和测量。
股骨颈前倾角(FNA)是股骨颈与股骨干之间的角度,表示股骨扭转的程度。 FNA 的差异通过力臂长度和关节负荷等因素的改变影响髋部的生物力学。与 FNA 差异相关的步态改变也可能导致包括骨关节炎在内的多种骨骼疾病的发生。在表面健康的成年人中,FNA 变化高达 30°。 FNA 在妊娠期间大幅增加,此后稳步下降直至成熟。有一些证据表明,从成年期到老年,这种下降的速度要低得多,但其背后的机制从未被研究过。 FNA 的发展似乎受到日常运动中所经历的机械力的强烈影响。运动受损的群体(例如臀位出生的儿童或患有脑瘫等神经肌肉疾病的个体)的 FNA 存在巨大差异就证明了这一点。可以使用多种方法来评估 FNA,同一参与者可能会产生高达 20° 的不同值。虽然 MRI 和 CT 在临床上使用,但其成本、扫描时间和电离辐射暴露等限制限制了它们在纵向和人群研究中的适用性,特别是在儿童中。更广泛地说,存在超声波和功能测试等适用的措施,但它们的可靠性和有效性较差。这些问题突出表明需要一种有效且可靠的普遍接受的方法。临床上有问题的 FNA 的治疗通常是去旋转截骨术;被动的、非手术的方法没有任何效果。 尽管有观察证据表明体力活动对 FNA 发育的影响,但有针对性的体力活动的功效仍未得到探索。本综述的目的是描述 FNA 的生物力学和临床后果、影响 FNA 的因素以及用于评估 FNA 的不同方法的优缺点。
更新日期:2020-06-24
中文翻译:
股骨前倾角:意义和测量。
股骨颈前倾角(FNA)是股骨颈与股骨干之间的角度,表示股骨扭转的程度。 FNA 的差异通过力臂长度和关节负荷等因素的改变影响髋部的生物力学。与 FNA 差异相关的步态改变也可能导致包括骨关节炎在内的多种骨骼疾病的发生。在表面健康的成年人中,FNA 变化高达 30°。 FNA 在妊娠期间大幅增加,此后稳步下降直至成熟。有一些证据表明,从成年期到老年,这种下降的速度要低得多,但其背后的机制从未被研究过。 FNA 的发展似乎受到日常运动中所经历的机械力的强烈影响。运动受损的群体(例如臀位出生的儿童或患有脑瘫等神经肌肉疾病的个体)的 FNA 存在巨大差异就证明了这一点。可以使用多种方法来评估 FNA,同一参与者可能会产生高达 20° 的不同值。虽然 MRI 和 CT 在临床上使用,但其成本、扫描时间和电离辐射暴露等限制限制了它们在纵向和人群研究中的适用性,特别是在儿童中。更广泛地说,存在超声波和功能测试等适用的措施,但它们的可靠性和有效性较差。这些问题突出表明需要一种有效且可靠的普遍接受的方法。临床上有问题的 FNA 的治疗通常是去旋转截骨术;被动的、非手术的方法没有任何效果。 尽管有观察证据表明体力活动对 FNA 发育的影响,但有针对性的体力活动的功效仍未得到探索。本综述的目的是描述 FNA 的生物力学和临床后果、影响 FNA 的因素以及用于评估 FNA 的不同方法的优缺点。