Kernbach Klaus J, Barkan Howard, Blitz Neal M
Department of Podiatry, Kaiser Foundation Hospital, Vallejo, CA 94589, USA.
Clin Podiatr Med Surg. 2010 Jan;27(1):135-43. doi: 10.1016/j.cpm.2009.08.007.
Symptomatic middle facet talocalcaneal coalition is frequently associated with rearfoot arthrosis that is often managed surgically with rearfoot fusion. However, no objective method for classifying the extent of subtalar joint arthrosis exists. No study has clearly identified the extent of posterior facet arthrosis present in a large cohort treated surgically for talocalcaneal coalition through preoperative computerized axial tomography. The authors conducted a retrospective review of 21 patients (35 feet) with coalition who were surgically treated over a 12-year period for coalition on at least 1 foot. Using a predefined original staging system, the extent of the arthrosis was categorized into normal or mild (Stage I), moderate (Stage II), and severe (Stage III) arthrosis. The association of stage and age is statistically significant. All of the feet with Stage III arthrosis had fibrous coalitions. No foot with osseous coalition had Stage III arthrosis. The distribution of arthrosis staging differs between fibrous and osseous coalitions. Only fibrous coalitions had the most advanced arthrosis (Stage III), whereas osseous coalitions did not. This suggests that osseous coalitions may have a protective effect in the prevention of severe degeneration of the subtalar joint. Concomitant subtalar joint arthrosis severity progresses with age; surgeons may want to consider earlier surgical intervention to prevent arthrosis progression in patients with symptomatic middle facet talocalcaneal coalition.
有症状的中关节面距跟联合常与后足关节病相关，而后足关节病通常通过后足融合术进行手术治疗。然而，目前尚无客观方法对距下关节病的程度进行分类。尚无研究通过术前计算机断层扫描明确在接受距跟联合手术治疗的大型队列中后关节面关节病的程度。作者对21例（35足）联合患者进行了回顾性研究，这些患者在12年期间至少有1足因联合接受了手术治疗。使用预先定义的原始分期系统，将关节病的程度分为正常或轻度（I期）、中度（II期）和重度（III期）关节病。分期与年龄的关联具有统计学意义。所有III期关节病的足均为纤维性联合。没有骨性联合的足出现III期关节病。关节病分期的分布在纤维性联合和骨性联合之间有所不同。只有纤维性联合出现最严重的关节病（III期），而骨性联合则没有。这表明骨性联合可能对预防距下关节的严重退变具有保护作用。伴发的距下关节病严重程度随年龄增长而进展；外科医生可能需要考虑更早进行手术干预，以防止有症状的中关节面距跟联合患者的关节病进展。
