Kamegaya M, Shinohara Y, Kokuji Y, Moriya H
Chiba Children's Hospital, Division of Orthopaedic Surgery, Chiba City, Japan.
Clin Orthop Relat Res. 2000 Oct(379):218-23. doi: 10.1097/00003086-200010000-00025.
Three-dimensional analyses of clubfoot in infants younger than 1 year of age were done using magnetic resonance imaging in an in vivo study. Twenty-one patients (31 feet) with congenital clubfoot were examined. The average age at examination was 8.6 months (range, 4-12 months). All patients originally were treated using corrective casts. Seventeen feet required complete subtalar release operations and the remaining 14 feet were treated conservatively with various orthoses. Four measurements using magnetic resonance imaging were performed in the transverse and coronal planes as follows: the calcaneus adduction angle, to define the degree of medial rotation of the calcaneus in the transverse plane; the navicular angle, to define the degree of medial displacement of the navicular; the talus neck angle, to define the degree of medial angulation of the talus; and the calcaneus shift index, to define the degree of medial shift of the calcaneus beneath the talar head in the coronal plane. In the results, all four measurements of clubfoot on magnetic resonance imaging were statistically different from those of normal feet. In the surgical group there were statistical differences in the calcaneus adduction angle, the navicular angle, and the calcaneus shift index (including two feet of patients whose parents had rejected proposed treatment), compared with the conservative group, but there was no statistical difference in the talus neck angle. Magnetic resonance imaging could delineate the three-dimensional abnormalities of the tarsal bones in clubfoot and quantitatively evaluate the severity of clubfoot.
在一项活体研究中，使用磁共振成像对1岁以下婴儿的马蹄内翻足进行了三维分析。对21例（31只脚）先天性马蹄内翻足患者进行了检查。检查时的平均年龄为8.6个月（范围4 - 12个月）。所有患者最初均采用矫正石膏治疗。17只脚需要进行完全距下关节松解手术，其余14只脚采用各种矫形器进行保守治疗。在横断和冠状面上使用磁共振成像进行了四项测量，如下：跟骨内收角，用于定义跟骨在横断面上的内旋程度；舟骨角，用于定义舟骨的内移程度；距骨颈角，用于定义距骨的内成角程度；跟骨移位指数，用于定义跟骨在冠状面上在距骨头下方的内移程度。结果显示，磁共振成像上马蹄内翻足的所有四项测量结果与正常足部相比均有统计学差异。与保守治疗组相比，手术组在跟骨内收角、舟骨角和跟骨移位指数方面存在统计学差异（包括两名家长拒绝提议治疗的患者的两只脚），但距骨颈角无统计学差异。磁共振成像能够描绘马蹄内翻足中跗骨的三维异常，并定量评估马蹄内翻足的严重程度。
