본문 바로가기
KERD
논문KCI 등재

A New Instrument for Measuring Tibial Torsion in Pediatric Patients

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

주제분류재활의학

초록

Objective To develop and test the validity and reliability of a new instrument for measuring the thigh-foot angle (TFA) for the patients with in-toeing and out-toeing gait.Methods The new instrument (Thigh-Foot Supporter [TFS]) was developed by measuring the TFA during regular examination of the tibial torsional status. The study included 40 children who presented with in-toeing and out-toeing gaits. We took a picture of each case to measure photographic-TFA (P-TFA) in the proper position and to establish a criterion. Study participants were examined by three independent physicians (A, B, and C) who had one, three and ten years of experience in the field, respectively. Each examiner conducted a separate classical physical examination (CPE) of every participant using a gait goniometer followed by a TFA assessment of each pediatric patient with or without the TFS. Thirty minutes later, repeated in the same way was measured.Results Less experienced examiner A showed significant differences between the TFA values depending on whether TFS used (left p=0.003 and right p=0.008). However, experienced examiners B and C did not show significant differences. Using TFS, less experienced examiner A showed a high validity and all examiner’s inter-test and the inter-personal reliabilities increased. Conclusion TFS may increase validity and reliability in measuring tibial torsion in patients who has a rotational problem in lower extremities. It would be more useful in less experienced examiners.

Abstract

Objective To develop and test the validity and reliability of a new instrument for measuring the thigh-foot angle (TFA) for the patients with in-toeing and out-toeing gait.Methods The new instrument (Thigh-Foot Supporter [TFS]) was developed by measuring the TFA during regular examination of the tibial torsional status. The study included 40 children who presented with in-toeing and out-toeing gaits. We took a picture of each case to measure photographic-TFA (P-TFA) in the proper position and to establish a criterion. Study participants were examined by three independent physicians (A, B, and C) who had one, three and ten years of experience in the field, respectively. Each examiner conducted a separate classical physical examination (CPE) of every participant using a gait goniometer followed by a TFA assessment of each pediatric patient with or without the TFS. Thirty minutes later, repeated in the same way was measured.Results Less experienced examiner A showed significant differences between the TFA values depending on whether TFS used (left p=0.003 and right p=0.008). However, experienced examiners B and C did not show significant differences. Using TFS, less experienced examiner A showed a high validity and all examiner’s inter-test and the inter-personal reliabilities increased. Conclusion TFS may increase validity and reliability in measuring tibial torsion in patients who has a rotational problem in lower extremities. It would be more useful in less experienced examiners.

참고문헌 (25)

  1. Jang SH, "Relationship between femoral anteversion and tibial torsion in intoeing gait", J Korean Acad Rehabil Med, 23, pp.390~396 (1999)
  2. Kumar SJ, "Torsional abnormalities in children’s lower extremities", Orthop Clin North Am, 13, pp.629~639 (1982)
  3. Sass P, "Lower extremity abnormalities in children", Am Fam Physician, 68, pp.461~468 (2003)
  4. Fabry G, "Normal and abnormal torsional development in children", Clin Orthop Relat Res, (302), pp.22~26 (1994)
  5. Butler-Manuel PA, "Measurement of tibial torsion: a new technique applicable to ultrasound and computed tomography", Br J Radiol, 65, pp.119~126 (1992)
  6. Clementz BG, "Assessment of tibial torsion employing fluoroscopy, computed tomography and the cryosectioning technique", Acta Radiol, 30, pp.75~80 (1989)
  7. Jakob RP, "Tibial torsion calculated by computerized tomography and compared to other methods of measurement", J Bone Joint Surg Br, 62-B, pp.238~242 (1980)
  8. Staheli LT, "Lower-extremity rotational problems in children. Normal values to guide management", J Bone Joint Surg Am, 67, pp.39~47 (1985)
  9. Rethlefsen SA, "Causes of intoeing gait in children with cerebral palsy", J Bone Joint Surg Am, 88, pp.2175~2180 (2006)
  10. Li YH, "Intoeing gait in children", Hong Kong Med J, 5, pp.360~366 (1999)
  11. Kim SI, "Measurement of femoral anteversion using 3 dimensional imaging technique", J Korean Soc Picture Archiving Commun Syst, 1, pp.53~58 (1995)
  12. Arnold AS, "Internal rotation gait: a compensatory mechanism to restore abduction capacity decreased by bone deformity", Dev Med Child Neurol, 39, pp.40~44 (1997)
  13. Staheli LT, "Rotational problems in children", Instr Course Lect, 43, pp.199~209 (1994)
  14. Lincoln TL, "Common rotational variations in children", J Am Acad Orthop Surg, 11, pp.312~320 (2003)
  15. 김성수, "대퇴 전염각 증가에 대한 감염 절골술 및 외 고정", 대한정형외과학회지, 39(4), pp.361~365 (2004), 대한정형외과학회
  16. Kwon OY, "Reliability and validity of measures of hammer toe deformity angle and tibial torsion", Foot (Edinb), 19, pp.149~155 (2009)
  17. Hernandez RJ, "CT determination of femoral torsion", AJR Am J Roentgenol, 137, pp.97~101 (1981)
  18. Kitaoka HB, "Relationship between femoral anteversion and osteoarthritis of the hip", J Pediatr Orthop, 9, pp.396~404 (1989)
  19. Murphy SB, "Femoral anteversion", J Bone Joint Surg Am, 69, pp.1169~1176 (1987)
  20. Staheli LT, "In-toeing and out-toeing in children", J Fam Pract, 16, pp.1005~1011 (1983)
  21. Lee SH, "Tibial torsion in cerebral palsy: validity and reliability of measurement", Clin Orthop Relat Res, 467, pp.2098~2104 (2009)
  22. Milner CE, "A comparison of four in vivo methods of measuring tibial torsion", J Anat, 193(Pt 1), pp.139~144 (1998)
  23. Hyun Dong Kim, "Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait", Annals of Rehabilitation Medicine, 35(4), pp.491~498 (2011), 대한재활의학회
  24. Fabry G, "Normal and abnormal torsional development of the lower extremities", Acta Orthop Belg, 63, pp.229~232 (1997)
  25. Chung CY, "Steel’s gluteus medius and minimus advancement for in-toeing in spastic cerebral palsy", J Korean Orthop Assoc, 31, pp.27~32 (1996)

이 간행물의 다른 논문 (23건)