Wang Chen, Yang Junsheng, Wang Shaobai, Ma Xin, Wang Xu, Huang Jiazhang, Zhang Chao, Chen Li, Xu Jian, Geng Xiang, Wang Kan
Department of Orthopedics, Huashan Hospital, Fudan University, NO.12 Middle Wulumuqi Road, Jingan District, Shanghai, China.
Harvard Medical School, Boston, MA, USA.
J Orthop Surg Res. 2015 Oct 24;10:166. doi: 10.1186/s13018-015-0306-5.
The motion of the distal syndesmosis correlates highly with the instability, while an accurate kinematic description of the distal tibiofibular joint during normal gait has not previously been presented.
Sixteen healthy syndesmoses of sixteen living subjects (8 male and 8 female) were studied during stance phase of the normal gait. Data of CT scanning were collected first and used to create the 3D models of the distal tibia and fibula. The lateral X-ray images of the syndesmosis were captured by fluoroscopy when the subject was walking. Seven key-pose images were selected for subsequent 3D to 2D bone model registration and six degrees-of-freedom (DOF) motions of syndesmosis were then calculated. A validation experiment was also conducted to confirm the accuracy of the 3D/2D technique for the syndesmosis.
During the stance phase, the distal tibiofibular joint exhibited with 2.98 ± 1.10° of dorsi/plantarflexion, 5.94 ± 1.52° of inversion/eversion, and 5.99 ± 2.00° of internal/external rotation; 2.63 ± 1.05 mm on medial/lateral, 3.86 ± 1.65 mm on anterior/posterior, and 4.12 ± 1.53 mm on superior/inferior translation. From heel strike to mid-stance, the syndesmosis demonstrated 1.69° of dorsiflexion, 3.61° of eversion, and 3.95° of external rotation. Likewise, from mid-stance to heel-off, the syndesmosis presented 1.04° of plantarflexion, 4.95° of inversion, and 5.13° of internal rotation.
During the stance phase of normal gait, internal/external rotation and vertical motion play dominant roles in terms of rotation and translation, respectively.
下胫腓联合的运动与不稳定性高度相关，然而此前尚未有关于正常步态中下胫腓关节精确运动学描述的报道。
对16名活体受试者（8名男性和8名女性）的16个健康下胫腓联合在正常步态的站立期进行研究。首先收集CT扫描数据并用于创建胫骨远端和腓骨的三维模型。当受试者行走时，通过荧光透视法采集下胫腓联合的侧位X线图像。选择7个关键姿势图像用于后续的三维到二维骨模型配准，然后计算下胫腓联合的六个自由度运动。还进行了一项验证实验以确认三维/二维技术对下胫腓联合的准确性。
在站立期，下胫腓关节表现出2.98±1.10°的背屈/跖屈、5.94±1.52°的内翻/外翻以及5.99±2.00°的内旋/外旋；在内侧/外侧有2.63±1.05mm、前后方向有3.86±1.65mm以及上下方向有4.12±1.53mm的平移。从足跟触地到站立中期，下胫腓联合表现出1.69°的背屈、3.61°的外翻以及3.95°的外旋。同样，从站立中期到足跟离地，下胫腓联合表现出1.04°的跖屈、4.95°的内翻以及5.13°的内旋。
在正常步态的站立期，内旋/外旋和垂直运动分别在旋转和平移方面起主导作用。
