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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >The Cliff Sign: A New Radiographic Sign of Hip Instability
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The Cliff Sign: A New Radiographic Sign of Hip Instability

机译：悬崖标志：髋关节不稳定的新的放射学标志

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Background: The preoperative diagnosis of hip microinstability is challenging. Although physical examination maneuvers and magnetic resonance imaging findings associated with microinstability have been described, there are limited reports of radiographic features. In patients with microinstability, we observed a high incidence of a steep drop-off on the lateral edge of the femoral head, which we have named the “cliff sign.” Purpose: (1) To determine the relationship of the cliff sign and associated measurements with intraoperative microinstability and (2) to determine the interobserver reliability of these measurements. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 115 consecutive patients who underwent hip arthroscopy were identified. Patients with prior hip surgery, Legg-Calve-Perthes disease, fractures, pigmented villonodular synovitis, or synovial chondromatosis were excluded, resulting in the inclusion of 96 patients in the study. A perfect circle around the femoral head was created on anteroposterior pelvis radiographs. If the lateral femoral head did not completely fill the perfect circle, it was considered a positive cliff sign. Five additional measurements relating to the cliff sign were calculated. The diagnosis of microinstability was made intraoperatively by the (1) amount of traction required to distract the hip, (2) lack of hip reduction after initial traction release following joint venting, or (3) intraoperative findings consistent with hip microinstability. Continuous variables were analyzed through use of unpaired t tests and discrete variables with Fisher exact tests. Interobserver reliability (n = 3) was determined for each measurement. Results: Overall, 89% (39/44) of patients with microinstability had a cliff sign, compared with 27% of patients (14/52) without instability ( P & .0001). Conversely, 74% of patients with a cliff sign had microinstability, while only 12% of patients without a cliff sign had instability ( P & .0001). In women younger than 32 years with a cliff sign, 100% (20/20) were diagnosed with instability. No differences were found in any of the 5 additional measurements. Excellent interobserver reliability was found for the presence of a cliff sign and the cliff angle measurement. Conclusion: We have identified a radiographic finding, the cliff sign, that is associated with the intraoperative diagnosis of hip microinstability and has excellent interobserver reliability. Results showed that 100% of young women with a cliff sign had intraoperative microinstability. The cliff sign may be useful in the preoperative diagnosis of hip microinstability.
机译：背景：术前对髋关节微不稳定性的诊断具有挑战性。尽管已经描述了与微不稳定性相关的体格检查操作和磁共振成像发现，但放射线照相特征报道有限。在微不稳定患者中，我们观察到股骨头外侧边缘陡峭脱落的发生率很高，我们将其称为“悬崖征兆”。目的：（1）确定悬崖征象和相关测量值与术中微不稳定性的关系，以及（2）确定这些测量值的观察者间可靠性。研究设计：队列研究（诊断）;证据等级：2。方法：总共鉴定出115例接受了髋关节镜检查的患者。先前接受过髋关节手术，Legg-Calve-Perthes病，骨折，色素沉着绒毛状滑膜炎或滑膜软骨病的患者被排除在外，因此本研究共纳入96名患者。在骨盆前后位片上创建一个围绕股骨头的完美圆圈。如果外侧股骨头没有完全填满完美的圆，则认为它是正悬崖征象。计算了与悬崖标志有关的五个附加测量值。术中可通过以下方法诊断微不稳定性：（1）牵开髋部所需的牵引力，（2）关节通气后最初的牵引释放后缺乏髋关节复位或（3）术中发现的与髋关节微不稳定相符的结果。通过使用不成对的t检验和使用Fisher精确检验的离散变量来分析连续变量。每次测量均确定了观察者之间的可靠性（n = 3）。结果：总体上，微不稳定的患者中有89％（39/44）有悬崖征兆，而无不稳定的患者中有27％（14/52）（P <.0001）。相反，具有悬崖征兆的患者中有74％具有微不稳定性，而没有悬崖征兆的患者中只有12％具有不稳定性（P ＜.0001）。在32岁以下有悬崖征兆的女性中，100％（20/20）被诊断为不稳定。在这5个其他测量中，没有发现差异。观察者对于出现悬崖迹象和测量悬崖角度发现了极好的可靠性。结论：我们确定了影像学发现，悬崖征象，与术中诊断髋关节微不稳定有关，并具有出色的观察者间可靠性。结果显示，有悬崖征兆的年轻妇女中有100％术中微不稳定。悬崖征兆可能在术前诊断髋关节微不稳定中有用。

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