Cam Type Femoro Acetabular Impingement Syndrome 진단에 이용되는 Alpha Angle 측정에 있어 Dunn View의 유용성에 관한 고찰 = - A Study on the Usefulness of Dunn View in Measuring Alpha Angle Used in the Diagnosis of Cam Type Femoro Acetabular Impingement Syndrome -

국문 초록 (Abstract)

적: Cam type Femoro Acetabular Impingement syndrome (FAI) 진단에 있어서 α각 (alpha angle)은 중요한 요소 중 하나이다. 이에 본 논문에서는 Dunn view (45˚,90˚)가 α각 측정에서 있어서 얼마나 유용한지를 Hip MRA와 AP view, Frog leg view, Trans Lateral view와의 비교 분석을 통해서 알아보고자 하였다.
대상 및 방법: 성인 남녀 66명을 대상으로 하였고 장비는 DR (digital diagnost TH, Philips, Netherland), MRI (Achieva 3.0T scanner, Philips, Netherlands)로 검사 하였고, α각 측정은 영상의학과 전문의 1명과 숙련된 방사선사 3명이 각각 측정 하였다. Hip MRA 에서 측정된 값을 Gold Standard로 하였고 Dunn 45˚ view, Dunn 90˚ view, AP view, Frog leg view와 Trans Lateral view의 측정 값 들을 각 각 정규성 검정을 통해 대응검정 T분석과 pearson 상관계수로 비교 분석 하였다.
결과: SPSS 통계 프로그램을 통해 분석하였으며 각각 측정값의 평균과 표준 편차는 MRA 47.3120˚±6.5480, AP view 63.4644˚±15.4772, Frog leg view 56.5708˚±9.9862, Trans Lateral view 49.0558˚±5.4949, Dunn 45˚ view 54.9586˚±8.4270, Dunn 90˚ view 47.8489˚±6.5138로 측정되었다. MRA와 Dunn 90˚ view의 평균차이는 0.3505, MRA와 Dunn 45˚ view는 0.9367, MRA와 Trans Lateral view는 0.7303, MRA와 Frog leg view는 1.3372, MRA와 AP view는 2.1088 이었다. MRA와 Dunn 90˚ view 는 p>0.05로 통계적으로 유의한 차이가 없었으며, MRA와 Dunn 45˚ view, Trans Lateral view, Frog leg view, AP view는 p<0.05로 통계적으로 유의한 차이가 있었다.결론: Dunn 90˚ view는 α각 측정이 비교적 정확하고 환자에게 시간, 비용 절감이 가능하며 조영제를 사용하지 않는 비침습적 검사라는 장점을 가진다. 그러나 통증이 심할 경우 Dunn 45˚, 90˚의 정확한 검사자세를 취할 수 없다는 점과 Dunn 45˚, 90˚ view의 검증된 device 및 accessory가 제작 되지 않아 검사자마다 flexion 및 abduction의 각도가 상이할 수 있다는 한계점이 있었다. 그러나 앞선 MRA와의 비교 결과에서도 알 수 있듯이 Dunn 90˚ view는 α각을 측정 하는데 매우 유용한 검사법이며 MRA 없이도 cam type FAI를 진단하는데 도움이 될 수 있다.

다국어 초록 (Multilingual Abstract)

Purpose: In the diagnosis of cam‐type FAI (Femoro Acetabular Impingement) syndrome, α angle is one of important factors. This study purposed to test the usefulness of Dunn view (45˚,90˚) in measuring α angle through comparative analysis of hip MRA and simple X‐ray tests AP view, frog leg view, and trans‐lateral view.
Materials and methods: The subjects of this study were 66 adult men and women, and test was conducted with DR (digital diagnost TH, Philips, Netherlands) and MRI (Achieva 3.0T scanner, Philips, Netherlands). In addition, α angle was measured by a radiologist and three experienced radiological technologists. The value measured in hip MRA was used as the Gold Standard, and values measured from Dunn 45˚ view, Dunn 90˚ view, AP view, frog leg view and trans‐lateral view were analyzed comparatively by paired t‐test and Pearson’s correlation through normality test.
Results: Data were analyzed through SPSS, and the mean and standard deviation of measurements were MRA 47.3120˚±6.5480, AP view 63.4644˚±15.4772, frog leg view 56.5708˚±9.9862, trans‐lateral view 49.0558˚±5.4949, Dunn 45˚ view 54.9586˚ ±8.4270, and Dunn 90˚ view 47.8489˚±6.5138. Difference in mean value was 0.3505 between MRA and Dunn 90˚ view, 0.9367 between MRA and Dunn 45˚ view, 0.7303 between MRA and trans‐lateral view, 1.3372 between MRA and frog leg view, and 2.1088 between MRA and AP view. The difference between MRA and Dunn 90˚ view was not statistically significant (p>0.05), and the differences between MRA and Dunn 45˚ view, tans‐lateral view, frog leg view and AP view were statistically significant (p<0.05).
Conclusion: Dunn 90˚ view was relatively accurate in measuring α angle. In addition,it saves time and cost for the patient, and is a non‐invasive examination without using contrast agent. On the other hand, it has the limitations that the patient cannot take the correct examination posture of Dunn 45˚ and 90˚ if pain is severe and that the angles of flexion and abduction may vary among examiners because there are no proven device and accessory for Dunn 45˚ and 90˚ view. As in the results of comparison with MRA shown above, however, Dunn 90˚ view is a very useful method to measure α angle and can be useful to diagnose cam‐type FAI without MRA.

목차 (Table of Contents)

• Ⅰ. 서 론
• Ⅱ . 대상 및 방법
• Ⅲ . 결 과
• Ⅳ. 고찰 및 결론