Nosewicz Tomasz L, Knupp Markus, Bolliger Lilianna, Henninger Heath B, Barg Alexej, Hintermann Beat
Department of Orthopaedic Surgery & Traumatology, Kantonsspital Baselland Liestal, Liestal, Switzerland.
Foot Ankle Int. 2014 May;35(5):453-62. doi: 10.1177/1071100714523589. Epub 2014 Mar 17.
Varus and valgus talar tilt in weight-bearing ankles can be explained by loss of peritalar stability allowing the talus to shift and rotate on the calcaneal and navicular surfaces. Little is known about the underlying destabilization process or the resulting talar malpositions. The purpose of this study was to determine talar position in 3 radiographic planes of varus and valgus tilted ankles.
Standard weight-bearing radiographs of 126 varus ankles (118 patients [mean age 62 ± 12 years]) and 81 valgus ankles (75 patients [mean age 65 ± 10 years]) were retrospectively evaluated. The tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle were used to determine the frontal, sagittal, and horizontal position of the talus. A control group was used for comparison.
Isolated talar varus malposition was found in 33.3% of the ankles (42/126), and malposition in 1 or both additional planes was found in 49.2% (62/126) and 17.5% (22/126), respectively. In valgus ankles, the percentages were 52% (42/81), 43% (35/81), and 5% (4/81), respectively. Seven out of 9 possible varus and 5 out of 9 possible valgus talar malposition configurations were found. The 4 predominant varus malposition configurations (89.7%, or 113/126) were dorsiflexion or neutral (sagittal plane) combined with neutral/external rotation and neutral/internal rotation (horizontal plane), respectively. The 3 predominant valgus malposition configurations (95%, or 77/81) were neutral or plantar flexion (sagittal plane) combined with neutral/external rotation and neutral (horizontal plane), respectively.
In varus and valgus tilted ankles, talar frontal plane alignment does not predict talar sagittal and horizontal position, indicating that peritalar instability leads to various talar malpositions. Prior to operative treatment of varus and valgus tilted ankles, thorough 3-dimensional analysis of talar position may minimize failure in properly balancing the talus within the ankle mortise.
Level III, retrospective comparative series.
负重位踝关节内翻和外翻时距骨倾斜可解释为距周稳定性丧失，使距骨在跟骨和舟骨表面发生移位和旋转。关于潜在的失稳过程或由此导致的距骨位置异常知之甚少。本研究的目的是确定内翻和外翻倾斜踝关节在三个放射学平面上的距骨位置。
回顾性评估126例内翻踝关节（118例患者，平均年龄62±12岁）和81例外翻踝关节（75例患者，平均年龄65±10岁）的标准负重位X线片。采用胫距关节面角、矢状面距跟倾斜角和水平面距第一跖骨角来确定距骨的额状面、矢状面和水平面位置。设立对照组进行比较。
33.3%（42/126）的踝关节存在孤立性距骨内翻位置异常，49.2%（62/126）和17.5%（22/126）的踝关节分别在另外一个或两个平面存在位置异常。在外翻踝关节中，相应比例分别为52%（42/81）、43%（35/81）和5%（4/81）。发现了9种可能的内翻距骨位置异常构型中的7种和9种可能的外翻距骨位置异常构型中的5种。4种主要的内翻位置异常构型（89.7%，即113/126）分别为背屈或中立位（矢状面）合并中立/外旋和中立/内旋（水平面）。3种主要的外翻位置异常构型（95%，即7个7/81）分别为中立位或跖屈（矢状面）合并中立/外旋和中立位（水平面）。
在内翻和外翻倾斜的踝关节中，距骨额状面排列不能预测距骨矢状面和水平面位置，这表明距周不稳定会导致多种距骨位置异常。在内翻和外翻倾斜踝关节的手术治疗前，对距骨位置进行全面的三维分析可能会减少在踝关节榫眼内正确平衡距骨失败的情况。
III级，回顾性比较系列研究。
