印度人群中成人跟骨关节面形态与距下关节不稳定及跟骨骨刺的相关性
Subtalar Joint Instability and Calcaneal Spurs Associated with the Configuration of the Articular Facets of Adult Human Calcaneum in Indian Population.
作者信息
Agarwal Shilpi, Garg Shilpi, Vasudeva Neelam
机构信息
Senior Resident, Department of Anatomy, Maulana Azad Medical College , New Delhi, India .
Director Professor and Head of Department, Department of Anatomy, Maulana Azad Medical College , New Delhi, India .
出版信息
J Clin Diagn Res. 2016 Sep;10(9):AC05-AC09. doi: 10.7860/JCDR/2016/20216.8444. Epub 2016 Sep 1.
INTRODUCTION
Morphological variations of articular facets of calcaneum may predispose people to joint instability, ligamentous laxity and development of arthritic changes in the subtalar joint. Knowledge of such variations is essential for treatment and diagnostic procedures in orthopaedic surgeries.
AIM
The aim of this study was to determine patterns of articular facets of calcanei and to establish its correlation with calcaneal spurs.
MATERIALS AND METHODS
The study was conducted on 580 adult calcanei of Indian origin at Maulana Azad Medical College and pattern of articular facets were observed and classified according to five patterns described in literature. A digital vernier calliper was used to measure separation between anterior and middle facet. Degree of intersecting angle between anterior and medial facets was calculated using UTHSCSA Image Tool software. The calcaneal spurs were observed by visual inspection.
RESULTS
Out of 580 calcanei, 66.55% had fused anterior and middle facets (Pattern I), 27.59% had all three facets separate (Pattern II), 5.52% had absence of anterior facet (Pattern III), 0.17% had all three facets fused (Pattern IV) and 0.17% had fused middle and posterior facets (Pattern V). A significant side variation was present in Pattern III with predominance on left side. Mean angle of intersection was 147.70 in Pattern I and 133.34 in Pattern II calcaneum. Calcaneal spurs were found in 61.38% out of which it was associated with Pattern I in 43.62%, Pattern II in 14.66% and Pattern III in 2.76%.
CONCLUSION
Individuals with Pattern I and III calcaneum were found to be at a greater risk of subtalar joint instability than individuals with Pattern II. Angle of intersection was obtuse in Pattern I which resulted in ligament laxity and unstable joint. Pattern I was more common in Indian population and this fact necessitates modifications of the western surgical techniques to suit the Indian scenario. An association between the presence of spur and facet configuration was found to be significant.
引言
跟骨关节面的形态变异可能使人们易患关节不稳定、韧带松弛以及距下关节的关节炎性改变。了解此类变异对于骨科手术的治疗和诊断程序至关重要。
目的
本研究的目的是确定跟骨关节面的模式，并建立其与跟骨骨刺的相关性。
材料与方法
在莫拉纳·阿扎德医学院对580例印度裔成年跟骨进行了研究，根据文献中描述的五种模式观察并分类跟骨关节面的模式。使用数字游标卡尺测量前关节面和中关节面之间的间距。使用UTHSCSA图像工具软件计算前关节面和内侧关节面之间的相交角度。通过目视检查观察跟骨骨刺。
结果
在580例跟骨中，66.55%的跟骨前关节面和中关节面融合（模式I），27.59%的跟骨三个关节面均分离（模式II），5.52%的跟骨无前关节面（模式III），0.17%的跟骨三个关节面均融合（模式IV），0.17%的跟骨中关节面和后关节面融合（模式V）。模式III存在显著的侧别差异，左侧更为常见。模式I跟骨的平均相交角度为147.70，模式II跟骨为133.34。61.38%的跟骨发现有骨刺，其中43.62%与模式I相关，14.66%与模式II相关，2.76%与模式III相关。
结论
发现模式I和模式III跟骨的个体比模式II跟骨的个体患距下关节不稳定的风险更高。模式I的相交角度为钝角，导致韧带松弛和关节不稳定。模式I在印度人群中更为常见，这一事实需要对西方手术技术进行改进以适应印度的情况。发现骨刺的存在与关节面构型之间存在显著关联。
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