Martus Jeffrey E, Femino John E, Caird Michelle S, Hughes Richard E, Browne Richard H, Farley Frances A
Department of Orthopaedics and Rehabilitation, Vanderbilt University, 2200 Children's Way, 4202 DOT, Nashville, TN 37232-9565, USA.
J Bone Joint Surg Am. 2008 Nov;90(11):2452-9. doi: 10.2106/JBJS.G.01230.
The accessory anterolateral talar facet may be associated with talocalcaneal impingement in the painful flatfoot. We performed an anatomic study to identify this accessory facet and its associated osteologic features.
Within the Hamann-Todd Human Osteological Collection, seventy-nine paired tali and calcanei were identified among forty-three skeletons from individuals who had had an average age of 13.4 years at the time of death. Each specimen was surveyed for an accessory anterolateral talar facet, a calcaneal neck anterior extension facet, a dorsal talar beak, and the talocalcaneal facet pattern. Measurements included the angle of Gissane, posterior facet inclination, calcaneal neck length, posterior facet length, overall calcaneal and talar lengths, and accessory facet dimensions. Lateral radiographs of specimens with accessory facets were made in neutral and everted subtalar alignment.
An accessory anterolateral talar facet was identified in twenty-seven (34%) of the seventy-nine specimens and was large in two (2.5%). Of the thirty-six skeletons with paired specimens, fifteen had an accessory facet and, of those, ten had the finding bilaterally. Degenerative changes or tarsal coalitions were not observed. Lateral radiographs demonstrated that subtalar eversion obscured observation of the facet. The accessory facet was associated with greater mean age (16.7 compared with 10.9 years; p < 0.0001), male sex (63% compared with 21%; p = 0.011), and a smaller mean angle of Gissane (116.2 degrees compared with 122.2 degrees; p = 0.018). Relative accessory facet volume was positively correlated with increased relative calcaneal posterior facet length (r = 0.53, p = 0.029). The accessory facet was significantly associated with dorsal talar beaking (29% compared with 4%; p = 0.028).
An accessory anterolateral talar facet was found in 34% of the specimens in a pediatric osteologic collection. The facet was associated with male sex, a smaller angle of Gissane, and dorsal talar beaking.
距骨前外侧副关节面可能与疼痛性平足中的距下关节撞击有关。我们进行了一项解剖学研究，以确定这个副关节面及其相关的骨学特征。
在哈曼-托德人体骨骼收藏中，从43具骨骼中识别出79对距骨和跟骨，这些个体死亡时的平均年龄为13.4岁。对每个标本进行检查，看是否存在距骨前外侧副关节面、跟骨颈前延伸关节面、距骨背侧喙以及距下关节面模式。测量包括吉桑角、后关节面倾斜度、跟骨颈长度、后关节面长度、跟骨和距骨的总长度以及副关节面尺寸。对有副关节面的标本进行中立位和距下关节外翻位的侧位X线片拍摄。
在79个标本中的27个（34%）中发现了距骨前外侧副关节面，其中2个（2.5%）较大。在36具配对标本的骨骼中，15个有副关节面，其中10个双侧都有此发现。未观察到退变改变或跗骨联合。侧位X线片显示距下关节外翻会遮挡对关节面的观察。副关节面与平均年龄较大（16.7岁对比10.9岁；p < 0.0001）、男性（63%对比21%；p = 0.011）以及较小的平均吉桑角（116.2度对比122.2度；p = 0.018）相关。副关节面相对体积与跟骨后关节面相对长度增加呈正相关（r = 0.53，p = 0.029）。副关节面与距骨背侧喙显著相关（29%对比4%；p = 0.028）。
在一个儿科骨骼收藏中，34%的标本发现有距骨前外侧副关节面。该关节面与男性、较小的吉桑角以及距骨背侧喙相关。
