Suckel A, Müller O, Herberts T, Langenstein P, Wülker N
Orthopädische Universitätsklinik Tübingen.
Z Orthop Unfall. 2008 Jan-Feb;146(1):86-91. doi: 10.1055/s-2007-965667.
Little has been known until now about biomechanical intra-articular changes in the condition of adjacent joints following subtalar arthrodeses.
We tested 5 cadaver specimens in a dynamic axially loaded foot model under computer-regulated load application on 9 extrinsic tendons of the foot regarding changes in load under native conditions and following an anatomically fixed subtalar arthrodesis.
We saw an averaged native force transmission in the talonavicular joint of 87 N, increasing post-arthrodesis to 92 N. In the calcaneocuboid joint we measured an increase from 72 N to 74 N. For peak pressure, the increase was from native 3152 kPa to 3286 kPa in the talonavicular joint and in the calcaneocuboid joint we recorded a reduction from 3282 kPa to 3277 kPa. The effects are not striking from a statistical viewpoint. However, we observed a reduction in force from native 103 N to 90 N and in peak pressure from 4778 kPa to 4261 kPa in the ankle. When the ankle was divided into discrete zones in the sagittal and frontal planes there was no evidence of load displacement.
Our measurements show that anatomically fixed arthrodeses of the talocalcanear joint do not lead to any striking increase in loads on adjacent joints. Any adjacent segment degeneration following subtalar arthrodeses may be the result of changes in joint kinematics or non-anatomically reconstructed hindfoot positions.
迄今为止，关于距下关节融合术后相邻关节状况的生物力学关节内变化，人们了解甚少。
我们在动态轴向加载足部模型中对5具尸体标本进行了测试，在计算机调节的载荷作用下，对足部的9条外在肌腱施加负荷，观察在自然状态下以及解剖学固定距下关节融合术后负荷的变化。
我们发现距舟关节的平均自然力传递为87牛，关节融合术后增加到92牛。在跟骰关节，我们测得从72牛增加到74牛。对于峰值压力，距舟关节从自然状态下的3152千帕增加到3286千帕，而在跟骰关节我们记录到从3282千帕降低到3277千帕。从统计学角度来看，这些影响并不显著。然而，我们观察到踝关节的力从自然状态下的103牛降低到90牛，峰值压力从4778千帕降低到4261千帕。当在矢状面和额状面将踝关节划分为离散区域时，没有负荷位移的证据。
我们的测量结果表明，距跟关节的解剖学固定融合术不会导致相邻关节负荷显著增加。距下关节融合术后任何相邻节段的退变可能是关节运动学变化或后足位置非解剖学重建的结果。
