University of Texas Medical Branch, Galveston, TX, USA.
Foot Ankle Int. 2013 Nov;34(11):1596-9. doi: 10.1177/1071100713499904. Epub 2013 Aug 9.
A cannulated lag screw inserted through the medial cuneiform into the base of the second metatarsal is often utilized to reduce the diastasis and aid healing of Lisfranc injuries. Also procedures such as a midfoot or a Lapidus arthrodesis require adequate implant-bone purchase in the medial cuneiform. The medial cuneiform contains cancellous bone of varying density. Knowledge of density variation may be helpful for implant usage and manufacturing of area specific implants.
In 60 randomly selected patients, mean computed tomography (CT) intensity in Hounsfield units was measured at 12 sampled locations within the medial cuneiform and served as a proxy for bone density. The patients' age, gender, and race were recorded. An analysis of variance (ANOVA) assessed the effect of age, gender, race, and sample site on bone density. Statistical testing assumed 95% level of confidence.
ANOVA showed age, gender, and sample site had significant effects (P < .001) on bone density, though race had no significant effect (P = .28). The distal-dorsal-lateral (DDL) site was significantly denser than all other sites (P < .001) except the middle-dorsal-lateral (MDL) (P = .53). The proximal-plantar-lateral (PPL) site was significantly less dense than all other sites (P < .001) except the middle-plantar-lateral/medial and the proximal-plantar-medial sites (P < .14). A general trend of density increasing in the distal and dorsal directions was evident, and within the dorsal sites there was a trend of increasing density in the lateral direction.
This is the first study to date to measure density of the medial cuneiform using living subjects. The sample size of 60 patients was also the largest of any study measuring density of this bone. We conclude that the densest area of the medial cuneiform is the most anterior, dorsal, and lateral portion.
The findings of this study may indicate the most optimal area for implant purchase in the medial cuneiform when reducing the diastasis between the base of the second metatarsal and medial cuneiform and for stabilization of the medial column.
通过内侧楔骨插入空心钉到第二跖骨基底常用于减少跖骨间分离并帮助跖骨骨折愈合。此外，中足或 Lapidus 融合术等手术也需要在内侧楔骨中获得足够的植入物-骨固定。内侧楔骨包含密度不同的松质骨。了解密度变化可能有助于植入物的使用和制造特定区域的植入物。
在 60 名随机选择的患者中，在 12 个内侧楔骨的采样点测量平均计算机断层扫描（CT）的亨氏单位强度，作为骨密度的替代指标。记录患者的年龄、性别和种族。方差分析（ANOVA）评估了年龄、性别、种族和采样点对骨密度的影响。统计检验假设置信度为 95%。
ANOVA 显示年龄、性别和采样点对骨密度有显著影响（P <.001），而种族没有显著影响（P =.28）。远背外侧（DDL）部位明显比其他部位（P <.001）密度高，除了中背外侧（MDL）（P =.53）。近足底外侧（PPL）部位明显比其他部位（P <.001）密度低，除了中足底外侧/内侧和近足底内侧部位（P <.14）。密度向远侧和背侧增加的总体趋势明显，在背侧部位，外侧方向的密度增加趋势明显。
这是迄今为止第一项使用活体受试者测量内侧楔骨密度的研究。60 名患者的样本量也是测量该骨密度的最大样本量。我们得出的结论是，内侧楔骨最密集的区域是最前、最背和最外侧的部分。
这项研究的结果可能表明，在减少第二跖骨基底和内侧楔骨之间的分离以及稳定内侧柱时，在内侧楔骨中植入物固定的最佳区域。
